Integrating emerging areas of nursing science into PhD programs

Prazosin as an Adjuvant to Increase Effectiveness of Duloxetine in a Rat Model of Oxaliplatin-Induced Peripheral Neuropathy

OBJECTIVES

Duloxetine, the only American Society of Clinical Oncology (ASCO) treatment recommended for chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors, is not effective for 40% of survivors. This study examined the ability of a duloxetine-prazosin combination to prevent the development of allodynia and hyperalgesia in a rat model of oxaliplatin-induced peripheral neuropathy (OPIN).

METHODS

Female (n = 24) and male (n = 41) rats were started on duloxetine (15 mg), prazosin (2 mg), or a duloxetine-prazosin combination one week prior to administration of the chemotherapy drug, oxaliplatin, and continued the duloxetine-prazosin combination for 32 days. Behavioral testing for mechanical allodynia and mechanical hyperalgesia was done with selected von Frey filaments over the course of the study.

RESULTS

Overall percent paw withdrawal for rats that received the duloxetine-prazosin combination was significantly lower in female (p < .001 for both conditions) and male (p = .029 for allodynia; p < .001 for hyperalgesia) than those that received water. No significant posttreatment differences were found for allodynia or hyperalgesia between rats treated with duloxetine and rats that received the duloxetine-prazosin combination in either sex.

CONCLUSIONS

These finding provide preliminary evidence that a duloxetine-prazosin combination can prevent the posttreatment development of allodynia and hyperalgesia in both male and female rats; however, the results suggest that the duloxetine-prazosin combination is no more efficacious than duloxetine alone in preventing chronic OIPN.

IMPLICATIONS FOR NURSING PRACTICE

The profession of nursing is built on clinical practice supported by scientific research. The current study addressed the clinical practice problem of prevention and management of painful OIPN, which is a priority area in oncology nursing.

Effectiveness of Duloxetine on Oxaliplatin-induced Allodynia and Hyperalgesia in Rats

Development of painful oxaliplatin-induced peripheral neuropathy (OIPN) is a major problem in people who receive oxaliplatin as part of cancer treatment. The pain experienced by those with OIPN can be seriously debilitating and lead to discontinuation of an otherwise successful treatment. Duloxetine is currently the only recommended treatment for established painful OIPN recommended by the American Society of Clinical Oncology, but its preventative ability is still not clear. This study examined the ability of duloxetine to prevent signs of chronic OIPN in female (n = 12) and male (n = 21) rats treated with the chemotherapeutic agent oxaliplatin. Using an established model of OIPN, rats were started on duloxetine (15 mg) one week prior to oxaliplatin administration and continued duloxetine for 32 days. Behavioral testing for mechanical allodynia and mechanical hyperalgesia was done with selected von Frey filaments. Significant posttreatment differences were found for allodynia in female (p = .004), but not male rats. Duloxetine was associated with significant differences for hyperalgesia in both female (p < .001) and male (p < .001) rats. These findings provide preliminary evidence of the preventative effects of duloxetine on both oxaliplatin-induced allodynia and hyperalgesia in male and female rats, with a difference noted in response between the sexes.

Three year nursing PhD curricula content among schools participating in the future of nursing scholars program

BACKGROUND

The Robert Wood Johnson Foundation (RWJF) Future of Nursing Scholars program (FNS) supported 45 nursing schools to create or adapt their PhD curricula to facilitate students completing a PhD degree in 3-years.

PURPOSE

This analysis characterized the PhD program curricula of 45 schools. Differences in curricula were examined based on school characteristics.

METHODS

Data were collected from five cohorts of school FNS applications. Summaries of curricula are provided and differences in curricula between schools were examined.

FINDINGS

Most of the PhD programs (73.3%) were at very high research intensive universities. A median of 60 credit hours were needed to complete a 3-year PhD. Most programs (84.0%) required year-round enrollment, oftentimes inclusive of summers, and placed an emphasis on scholars pursuing additional coursework to meet the 3-year timeline.

DISCUSSION

Findings highlight common elements of 3-year PhD curricula that can be utilized to inform the development and educational needs of future nurse scientists.

Research focused doctoral nursing education in the 21st century: Curriculum, evaluation, and postdoctoral considerations

The AACN position statement on The Research-Focused Doctoral Program in Nursing: Pathways to Excellence was revised in 2022 by an AACN Task Force charged with creating a new vision for the PhD and similar programs in nursing. This document, which was informed by hundreds of academic nursing stakeholders, yields expectations and recommendations for PhD program curriculum, program evaluation, post-doctoral competencies, and resources. Results of an AACN 2021 survey indicated increased enrollment in PhD programs 2017-2000. Fifteen percent of students were enrolled in BSN-PhD, programs, 70 % of schools reported external review, and overall average time to degree completion was 5 years. Considerations for the education for the research doctorate include development of curriculum that fosters the scholarship of discovery and scientific inquiry and implements systematic evaluation of program outcomes while advancing postdoctoral competencies and resources, including the post-doctoral fellowship. Comprehensive assessment of the PhD program promotes ongoing program analysis and quality. Postdoctoral fellowships advance the science of nursing via the creation of a culture and workforce for nursing research. Successful postdoctoral programs have mentors, resources, and infrastructure to adequately enable the fellow to progress in their line of inquiry and develop as an investigator.

A practice-based model to guide nursing science and improve the health and well-being of patients and caregivers

AIMS AND OBJECTIVES

The purpose of this paper is to describe a model to guide nursing science in a clinical practice-based setting. Exemplars are provided to highlight the application of this nursing research model, which can be applied to other clinical settings that aim to fill evidence gaps in the literature.

BACKGROUND

Nurse scientists are well positioned to develop new knowledge aimed at identifying global health solutions to multiple disparities. The generation and application of this knowledge are essential to inform and guide professional nursing practice. While a number of evidence-based practice models exist to guide the integration of literature findings and other sources of evidence into practice, there is a need for additional models that serve as a guide and focus for the conduct of research in distinct scientific areas in practice-based settings.

DESIGN

Model development and description.

METHODS

Mayo Clinic is a large, comprehensive healthcare system with a mission to address unmet patient needs through practice, research and education. PhD-prepared nurse scientists engage in practice-based research as an integral component of Mayo Clinic's mission. A practice-based nursing research model was developed with the intent to advance nursing research in a clinical setting.

RESULTS

The components of the Mayo Clinic Nursing Research model include symptom science, self-management science and caregiving science. The generation of nursing science is focused on addressing needs of patients with complex health conditions, inclusive of caregivers.

CONCLUSIONS

While clinical settings provide rich opportunities for the conduct of research, priorities need to be established in which to focus scientific endeavours. The Mayo Clinic Nursing Research model may be applicable to nurses around the globe who are engaged in the generation of knowledge to guide practice.

RELEVANCE TO CLINICAL PRACTICE

The Mayo Clinic Nursing Research model can be used by nurse scientists embedded in healthcare settings to address clinically relevant questions, advance the generation of new nursing knowledge and ultimately improve the health and well-being of patients and caregivers.

Redesigning a PhD measurement course for a new era in nursing science

Measurement is at the core of the research process. At the PhD level, students need to develop an in-depth understanding of measures relevant to their area of work and refine their knowledge of measurement issues. Traditionally, measurement coursework in Nursing focused on the psychometric evaluation of instruments measuring cognition and behavior. However, in the age of Big Data, precision medicine, and translational science, PhD students need to develop knowledge and skills relevant to these fields and to collaborate with experts from the different disciplines. Therefore, Nursing faculty need to recognize the state-of-the-science of nursing research and tend to a variety of measurement issues across a spectrum of operationalized concepts. Herein we present an overview of learning outcomes, instructional content and methods of delivery for a contemporary PhD-level course on measurement for Nursing Science. We also present our experience in the design, implementation, and evaluation of a novel PhD measurement course.

•

Integrating data science and translational research in measurement course

•

Providing advanced, multidisciplinary training to PhD students

•

Encouraging analytical thinking for use of advanced research methods

Emerging roles for research intensive Ph.D. prepared nurses as leaders and innovators: Views from funders/sponsors

Given the complexity and rapidly changing pace of 21st-century healthcare, the need for research intensive Ph.D. prepared nurses has never been greater. Philanthropic funders and sponsors of Ph.D. nursing education have important insights into how investments in Ph.D. education have direct and positive impacts on healthcare, and consequently bring important perspectives to emerging roles for Ph.D. prepared nurses. To elicit these perspectives focused questions were posed to four leading philanthropic funders/sponsors of Ph.D. nursing education: The Rita and Alex Hillman Foundation; The Robert Wood Johnson Foundation, Sigma Theta Tau- International Honor Society of Nursing, and the Jonas Nursing & Veterans Healthcare of Jonas Philanthropies. The interviews were conducted as part of a special session from the October 2019 PhD Summit "Re-Envisioning PhD Programs of the Future". A common theme that emerged from these discussions was the compelling need to prepare research intensive Ph.D. prepared nurses with advanced skills in leadership and innovation in order to leverage the larger impact of their work on health, health care and health policy. Lessons learned from the programs supported by these sponsors can be used to refine and implement future Ph.D. programs that provide the leadership and innovation skills required of research intensive Ph.D. prepared nurses.

Diffusion of Precision Health Into a Baccalaureate Nursing Curriculum

BACKGROUND

Precision health (PH) and precision medicine are emerging approaches to health care promising more individualized care for health consumers. This improved type of care management uses innovation in science and technology to accurately identify diseases, treatments, and environmental influences to provide effective and efficient care. Multiple industries are supporting this venture, including nursing.

METHOD

To respond to the national call to integrate PH in nursing curricula, a small urban university in Southern California proposed to integrate concepts of PH into six select courses in the baccalaureate curriculum.

RESULTS

This curriculum revision launched in fall 2020; it was the first time PH concepts were introduced to Bachelor of Science in Nursing students in the department of nursing. Student outcomes will be measured using the nine competencies developed.

CONCLUSION

Nurse educators shape future practice. It is incumbent upon them to adopt the opportunities for transformation presented by the emergent phenomenon of PH. Only then will students be prepared with the knowledge, skills, and attitudes foundational for precise care. [J Nurs Educ. 2021;60(2):107-110.].

Impact of nurse scientist-led digital health interventions on management of chronic conditions

BACKGROUND

Chronic conditions are a major contributor to the burden of disease worldwide. Using innovative digital health technologies, nurse scientists are well-positioned to lead efforts to reduce the burden of chronic conditions on individuals, communities, and systems.

PURPOSE

The purpose of this review was to summarize the outcomes commonly measured in nurse-led digital health interventions that target chronic conditions and pose recommendations for the education of future nurse scientists to lead these studies.

METHODS

A rapid review of the literature was completed using CINAHL and Ovid Emcare. Studies were included if the research: a) was led by a nurse; b) described outcomes of a digital health intervention; and c) included any population with a prevalent chronic condition.

FINDINGS

26 studies were included in this review. Nurse-led digital health interventions are being used to support and manage a range of chronic conditions in varied settings.

DISCUSSION

Digital health interventions are changing the delivery of healthcare for individuals living with chronic conditions. These interventions are bridging the gaps between the digital and physical worlds and are rapidly evolving.

CONCLUSION

The recommendations posed in this review reiterate the importance of robust content and methods education for nurse scientists to address future research needs in a digital era.

Global assessment instrument for quality of nursing doctoral education with a research focus: Validity and reliability study

OBJECTIVES

This study was designed to assess the content and construct validity and reliability of the Quality of Nursing Doctoral Education (QNDE) instrument for nursing doctoral programmes with a research focus.

DESIGN

A cross-sectional, survey study.

SETTINGS

Using Qualtrics survey, the research team sent emails to potential participants providing a link to the study and the QNDE instrument.

PARTICIPANTS

A total of 234 faculty and doctoral students participated: 17 faculty from 14 countries in the first stage; 111 faculty and 106 doctoral students from 20 countries in the second stage.

METHODS

The content validity, internal consistency reliability, and construct validity of the four domains (program, faculty, resources, and evaluation) of the QNDE were examined in two stages. Data were collected from purposive samples of faculty and students between June 2018 and March 2019. Confirmatory factor analysis was conducted in ordinal scale using robust weighted least square mean and variance (WLSMV) adjusted estimator in MPlus 8.

RESULTS

Content validity of the items in the four domains was accepted when the item showed content validity (I-CVI > 0.78). Internal consistency reliability in four domains was computed using Cronbach's alpha, α = 0.88 to 0.97. Construct validity of the QNDE was established by confirmatory factor analysis based on model fit statistics. Factor loading coefficients for all items in each domain were statistically significant (>0.5; p < .001).

CONCLUSIONS

Participation of 234 faculty and doctoral students from 20 countries on four continents confirmed content validity, internal consistency reliability, and construct validity of the QNDE instrument. These findings support the credibility of this revised QNDE instrument for assessing the quality of nursing doctoral education with a research focus. This is a significant step forward in enhancing the capability for evaluating doctoral programmes.

Application of project management tools and techniques to support nursing intervention research

Nursing research involves much planning and attention to details, yet novice and seasoned nurse researchers often overlook the day-to-day operations required to conduct research studies. Project management is a set of iterative steps that can facilitate the process of conducting nursing research. In this paper we aim to provide an overview of project management and identify ways in which its specific principles and strategies may be applied to facilitate nursing research. Here we give an overview of our current longitudinal study using a Solomon four-group design and illustrate how we applied strategies and tools from the project management literature. In addition, we offer descriptions and illustrations of several other project management tools that could have been used in specific phases of this research project. We encourage nurse educators and researchers to familiarize themselves with the principles of project management and consider using them in future studies.

Ripe for Disruption? Adopting Nurse-Led Data Science and Artificial Intelligence to Predict and Reduce Hospital-Acquired Outcomes in the Learning Health System

Nurse leaders are dually responsible for resource stewardship and the delivery of high-quality care. However, methods to identify patient risk for hospital-acquired conditions are often outdated and crude. Although hospitals and health systems have begun to use data science and artificial intelligence in physician-led projects, these innovative methods have not seen adoption in nursing. We propose the Petri dish model, a theoretical hybrid model, which combines population ecology theory and human factors theory to explain the cost/benefit dynamics influencing the slow adoption of data science for hospital-based nursing. The proliferation of nurse-led data science in health systems may be facing several barriers: a scarcity of doctorally prepared nurse scientists with expertise in data science; internal structural inertia; an unaligned national "precision health" strategy; and a federal reimbursement landscape, which constrains-but does not negate the hard dollar business case. Nurse executives have several options: deferring adoption, outsourcing services, and investing in internal infrastructure to develop and implement risk models. The latter offers the best performing models. Progress in nurse-led data science work has been sluggish. Balanced partnerships with physician experts and organizational stakeholders are needed, as is a balanced PhD-DNP research-practice collaboration model.

Genomics education in nursing in Hong Kong, Taiwan and Mainland China

AIM

To identify issues and challenges of genomics education in Hong Kong, Taiwan and Mainland China.

BACKGROUND

The use of genetics/genomics in health care, such as genetic testing, pharmacogenomics and tumour profiling in the context of cancer, is increasing. The rapid application of genetics/genomics in clinical practice requires healthcare providers to be competent to practise genetics-related patient care.

SOURCES OF EVIDENCE

We reviewed current practices in genomics education in nursing in Hong Kong, Taiwan and Mainland China, including the opportunities for nurses to advance their knowledge and recommendations to incorporate genomics education in the nursing curriculum in these regions.

FINDINGS

While many citizens and health professionals recognize the importance of new and exciting research areas of genomics/genetics, there are still many gaps in the translation of genetic/genomic medicine into clinical practice. There is also a similar lack of genetics professionals in China.

CONCLUSION

Hong Kong, Taiwan and Mainland China face challenges in promoting genetic education in nursing. A strategic approach in a coordinated effort ineffectively translating genomic knowledge into healthcare practice should be established in these three regions.

IMPLICATIONS FOR NURSING AND POLICY

Nursing educators in Hong Kong, Taiwan and Mainland China should link with the international nursing community (e.g. Global Genomics Nursing Alliance) and form closer networks to improve education in the area of genetics and genomics. From a policy level, genomics education is suggested to be incorporated in nursing curriculum to enhance nurses' competency in incorporating genetics/genomics service into patient care.

Precision health research and implementation reviewed through the conNECT framework

BACKGROUND

Precision health is a population-based approach that incorporates big-data strategies to understand the complex interactions between biological, environmental, lifestyle, and psychosocial factors that influence health.

PURPOSE

A promising tool to facilitate precision health research and its dissemination is the ConNECT Framework.

METHODS

Here, we discuss the relationship of the five broad and synergistic principles within the ConNECT Framework as they may apply to nursing science research: (1) Integrating Context, (2) Fostering a Norm of Inclusion, (3) Ensuring Equitable Diffusion of Innovations, (4) Harnessing Communication Technology, and (5) Prioritizing Specialized Training.

DISCUSSION/CONCLUSION

The principles within this framework can be used by nurse scientists and educators to guide and disseminate precision health research.

Nursing genetics and genomics: The International Society of Nurses in Genetics (ISONG) survey

BACKGROUND

The International Society of Nursing in Genetics (ISONG) fosters scientific and professional development in the discovery, interpretation, and application of genomic information in nursing research, education, and clinical practice.

OBJECTIVES

Assess genomic-related activities of ISONG members in research, education and practice, and competencies to serve as global leaders in genomics.

DESIGN

Cross-sectional survey (21-items) assessing genomic-related training, knowledge, and practice.

SETTINGS

An email invitation included a link to the anonymous online survey.

PARTICIPANTS

All ISONG members (n = 350 globally) were invited to partake.

METHODS

Descriptive statistics and Wilcoxon Rank Sum Test for between-group comparisons.

RESULTS

Respondents (n = 231, 66%), were mostly Caucasian, female, with a master's degree or higher. Approximately 70% wanted to incorporate genomics in research, teaching, and practice. More than half reported high genomic competency, and over 95% reported that genomics is relevant the next 5 years.

CONCLUSIONS

Findings provide a foundation for developing additional educational programs for an international nursing workforce in genomics.

Quantity and Quality of Economic Evaluations in U.S. Nursing Research, 1997-2015: A Systematic Review

BACKGROUND

The United States has a complex healthcare system that is undergoing substantial reformations. There is a need for high-quality, economic evaluations of nursing practice. An updated review of completed economic evaluations relevant to the field of nursing within the U.S. healthcare system is timely and needed.

OBJECTIVES

The purpose of this study was to evaluate and describe the quantity and quality of economic evaluations in nursing-relevant research performed in the United States between 1997 and 2015.

METHODS

Four databases were searched. Titles, abstracts, and full-text content were reviewed to identify studies that analyzed both costs and outcomes, relevant to nursing, performed in the United States, and used the quality-adjusted life year to measure effectiveness. For included studies, data were extracted from full-text articles using criteria from U.S. Public Health Service's Panel on Cost-Effectiveness in Health and Medicine.

RESULTS

Twenty-eight studies met the inclusion criteria. Most (n = 25, 89%) were published in the last decade of the analysis, from 2006 to 2015. Assessment of quality, based on selected items from the panel guidelines, found that the evaluations did not consistently use the recommended societal perspective, use multiple resource utilization categories, use constant dollars, discount future costs and outcomes, use a lifetime horizon, or include an indication of uncertainty in results. The only resource utilization category consistently included across studies was healthcare resources.

DISCUSSION

Only 28 nursing-related studies meeting the inclusion criteria were identified as meeting robust health economic evaluation methodological criteria, and most did not include all important guideline items. Despite increases in absolute numbers of published studies over the past decade, economic evaluation has been underutilized in U.S. nursing-relevant research in the past two decades.

Nursing Practice, Research and Education in the West: The Best Is Yet to Come

PURPOSE

This paper celebrates the 60th anniversary of the Western Institute of Nursing, the nursing organization representing 13 states in the Western United States, and envisions a preferred future for nursing practice, research, and education.

BACKGROUND

Three landmark calls to action contribute to transforming nursing and healthcare: the Patient Protection and Affordable Care Act of 2010; the Institute of Medicine report Future of Nursing: Leading Change, Advancing Health; and the report Advancing Healthcare Transformation: A New Era for Academic Nursing. Challenges abound: U.S. healthcare remains expensive, with poorer outcomes than other developed countries; costs of higher education are high; our profession does not reflect the diversity of the population; and health disparities persist. Pressing health issues, such as increases in chronic disease and mental health conditions and substance abuse, coupled with aging of the population, pose new priorities for nursing and healthcare.

DISCUSSION

Changes are needed in practice, research, and education. In practice, innovative, cocreated, evidence-based models of care can open new roles for registered nurses and advanced practice registered nurses who have knowledge, leadership, and team skills to improve quality and address system change. In research, data can provide a foundation for clinical practice and expand our knowledge base in symptom science, wellness, self-management, and end-of-life/palliative care, as well as behavioral health, to demonstrate the value of nursing care and reduce health disparities. In education, personalized, integrative, and technology-enabled teaching and learning can lead to creative and critical thinking/decision-making, ethical and culturally inclusive foundations for practice, ensure team and communication skills, quality and system improvements, and lifelong learning.

CONCLUSION

The role of the Western Institute of Nursing is more relevant than ever as we collectively advance nursing, health, and healthcare through education, clinical practice, and research.

Comparative and cost-effectiveness research: Competencies, opportunities, and training for nurse scientists

BACKGROUND

Comparative and cost-effectiveness research develops knowledge on the everyday effectiveness and value of treatments and care delivery models.

PURPOSE

To describe comparative and cost-effectiveness research; identify needed competencies for this research; identify federal funding; and describe current training opportunities.

METHODS

Published recommended competencies were reviewed. Current federal funding and training opportunities were identified. A federally funded training program and other training opportunities are described.

DISCUSSION

Fourteen core competencies were identified that have both analytic and theoretical foci from nursing and other fields. There are multiple sources of federal funding for research and training. Interdisciplinary training is needed.

CONCLUSION

Comparative and cost-effectiveness research has the opportunity to transform health care delivery and improve the outcomes of patients. Nurses, as clinicians and scientists, are in a unique position to contribute to this important research. We encourage nurses to seek the needed interdisciplinary research training to participate in this important endeavor. We also encourage educators to use the competencies and processes identified in current training programs to help shape their doctoral programs.

Again, What Is Nursing Science?

This article again asks, What is nursing science? Who knows? Who cares? The author describes the threat to the survival of nursing science grounded in nursing frameworks and theories. This threat is magnified by the proposal of the Council for the Advancement of Nursing Science (CANS) to change the curricula of PhD education. The aim of CANS is to prepare nurse scientists for lifelong competitive careers in interdisciplinary research, often focused on funding priorities of the National Institute of Nursing Research (NINR). Curricula would include preparation for conducting research in topics such as omics, e-science, translation science, biobehavioral science, symptom science, and team science. How can this be nursing science? It is argued that this focus might obliterate nursing’s discipline-specific phenomenon of concern, the human-universe-health process.

Assuring a strong foundation for our nation's public health systems

BACKGROUND

A strong public health infrastructure is necessary to assure that every community is capable of carrying out core public health functions (assessment of population health, assurance of accessible and equitable health resources, and development of policies to address population health) to create healthy conditions. Yet, due to budget cuts and inconsistent approaches to base funding, communities are losing critical prevention and health promotion services and staff that deliver them.

PURPOSE

This article describes key components of and current threats to our public health infrastructure and suggests actions necessary to strengthen public health systems and improve population health.

DISCUSSION

National nursing and public health organizations have a duty to advocate for policies supporting strong prevention systems, which are crucial for well-functioning health care systems and are fundamental goals of the nursing profession.

CONCLUSION

We propose strengthening alliances between nursing organizations and public health systems to assure that promises of a reformed health system are achieved.

Educating future nursing scientists: Recommendations for integrating omics content in PhD programs

Preparing the next generation of nursing scientists to conduct high-impact, competitive, sustainable, innovative, and interdisciplinary programs of research requires that the curricula for PhD programs keep pace with emerging areas of knowledge and health care/biomedical science. A field of inquiry that holds great potential to influence our understanding of the underlying biology and mechanisms of health and disease is omics. For the purpose of this article, omics refers to genomics, transcriptomics, proteomics, epigenomics, exposomics, microbiomics, and metabolomics. Traditionally, most PhD programs in schools of nursing do not incorporate this content into their core curricula. As part of the Council for the Advancement of Nursing Science's Idea Festival for Nursing Science Education, a work group charged with addressing omics preparation for the next generation of nursing scientists was convened. The purpose of this article is to describe key findings and recommendations from the work group that unanimously and enthusiastically support the incorporation of omics content into the curricula of PhD programs in nursing. The work group also calls to action faculty in schools of nursing to develop strategies to enable students needing immersion in omics science and methods to execute their research goals.