•Paper explores barriers to a universal DNP requirement for advanced practice nurses•Includes cost analysis and perceptions of the DNP in today's professional environment•Offers insight to help ...facilitate the implementation of a universal DNP standard
In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry.
The purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs.
Deans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education.
This paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition.
This paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.
•A dedicated program to support non-tenure track faculty facilitates scholarship initiatives.•Fostering and supporting non-tenure track scholarship is critical for advancing knowledge, strengthening ...student educational programs, as well as facilitating the promotion and retention of nurse clinician educators.
Primary fungal diseases in marine mammals are rare. Mucormycosis, a disease caused by fungi of the order Mucorales, has been documented in few cetaceans and pinnipeds. In 2012, the first case of ...mucormycosis in the Pacific Northwest was documented in a dead stranded harbor porpoise (Phocoena phocoena) in Washington state. Since then, mucormycosis has been detected in a total of 21 marine mammals; fifteen harbor porpoises, five harbor seals (Phoca vitulina), and one southern resident killer whale (Orcinus orca). Infected animals were predominately found in the inland waters of Washington and British Columbia, and one harbor seal was recovered in northern Oregon. Fungal hyphae were detected histologically in a variety of tissues, including brain, lung, spleen, pancreas, kidneys, muscle, lymph nodes, and skin. Three fungal species were identified from seven cases by PCR screening or fungal culture; Rhizomucor pusillus (four cases), Lichtheimia corymbifera (two cases), and Cunninghamella bertholletiae. Underlying conditions such as emaciation, current or recent pregnancy, multisystemic parasitism, protozoal infection, and herpesvirus were found in several affected animals. Reasons for the appearance and subsequent increase of these fungal infections in marine mammals are unknown. The emergence of this disease as a source of marine mammal mortality in the Pacific Northwest is of particular concern for endangered southern resident killer whales that spend time in this region. Current population-level stressors such as insufficient prey, high levels of contaminants, and noise pollution, could predispose them to these fatal infections.
Concerns about U.S. nursing research workforce preparation and success in the research arena require information about support mechanisms and readiness because the first research position is key to ...researcher retention and success.
The purpose was to describe the state of junior nursing research faculty recruitment terms, nursing programs' support during the first 2 years of employment, and administrators' views about strengths and weaknesses of the junior nursing research faculty pool and adequacy of the support provided.
Survey administrators in all U.S. nursing programs offering research doctorates (n = 125; response rate: 52%).
Resource availability varied widely across institutions. Most respondents reported resources were adequate regardless of the actual level provided. Administrators' teaching and research expectations of these faculty also varied widely. Administrators identified readiness to perform as an issue of concern.
As consumers of nursing research program graduates and as administrators responsible for the nursing research enterprise, deans need to take collective as well as individual actions.
•Junior research faculty are modest at most nursing schools.•Deans report widespread deficiencies in new researchers.•Role expectations of junior research faculty vary widely.•Addressing resources, initial training, and role expectations may advance nursing research.•Identifying how other scientific disciplines support beginning researchers may suggest new models.
Concern regarding newly licensed registered nurses' abilities to cope with the increasing complexity of care has led to the development of a variety of nurse residency program (NRP) initiatives. The ...unknowns are the extent to which and how various program elements are implemented across NRPs. Without understanding the extent to which NRPs deliver the same program, determination of their impact on care is limited. The purpose of this study was to describe U.S. NRPs and thereby identify the extent of treatment fidelity across programs.
Program attributes were measured using a 24-item survey based on the outcomes production conceptual framework. The survey was sent to known NRP directors or chief nursing officers at the 1,011 U.S. hospitals having 250 or more inpatient beds; 203 surveys (a 20% response rate) were returned.
Almost half (48%) of hospitals reported operating an NRP. NRP models included University HealthSystems Consortium (22%), facility based (54%), and “other” (24%). Significant (p < .01) differences were noted among and within program model types in terms of career planning, project requirements and types, and mentoring.
The extent of differences within and across program types indicates a lack of treatment fidelity needed to detect objectively the impact of the NRP as a discrete intervention on patient outcomes. NRP expansion may be limited by the number of hospitals of a size most likely able to support such programs.
Recent calls to expand the number of U.S. Doctors of Nursing Practice (DNPs) raises questions about programs' capacities, content and requirements, and their ability to expand. This paper aims to ...describe (1) key aspects of DNP program capacities that may provide direction for DNP program expansion plans, the timing of such expansion and program QI efforts; and (2) the impact of the DNP on faculty resources for research doctoral programs. A survey of all U.S. DNP programs (n = 130; response rate 72%) was conducted in 2011 based on previously tested items. Reviews of Web sites of nonresponding schools provided some data from all programs. Ratios of students to faculty active in advanced practice (AP) and in QI (QI) were high (AP 11.0:1, SD 10.1; QI 20.2:1, SD 17.0 respectively). There was wide variation in scholarly requirements (0–4: 50% of program had none) and program committee composition (1–5; mode=2). Almost all responding schools that offered PhD and DNP programs reported assigning research-active or potentially research-active faculty in both programs. The ability to expand programs while maintaining quality may be compromised by capacity issues. Addressing demand issues through the alignment of program requirements with societal and employment requirements may provide directions for addressing current DNP capacity issues.
Mucorales infections are increasing in frequency and are a One Health pathogen of concern. In humans and domestic animals, risk factors include being immunocompromised, elevated circulating serum ...iron, contaminated open wounds, or metabolic diseases such as ketoacidosis or uncontrolled diabetes. Mucormycosis was first identified in 2012 in Pacific Northwest marine mammals, predominantly in harbor porpoises. We performed an assessment to determine the overall qualitative risk, or risk score, of mucormycosis in harbor porpoises. Risk factors for this disease are unknown in aquatic mammals. In a separate risk factor analysis, potential risk factors such as pollutants, trace metals (e.g., iron), and co-infection with other pathogens (e.g., viruses and
Brucella
spp.) were examined in mucormycosis cases and noncases using a matched case-control study design, to determine the presence and strength of association of these factors with mucormycosis. Disease severity (gross and histopathology) and exposure scores were multiplied together to obtain the overall risk scores of 9 -16 which corresponded to moderate and severe, respectively. In the risk factor analysis, the factors most strongly associated with a mucormycosis case, relative to a control, were elevated liver iron, decreased blubber thickness, and the decreased ratio of the sum of PCB congeners/sum of PBDE congeners. The results of this study suggest that mucormycosis may pose an inordinately high risk to harbor porpoises (and potentially sympatric species in the Salish Sea such as southern resident killer whales) based on the detected prevalence and the severity of lesions observed at necropsy. However, the risk may be greater on an individual basis compared to the overall population, and is likely related to other factors such as increased POP and heavy metal burdens.
BackgroundStroke is a major cause of death or long-term disability worldwide. Many patients with stroke receive integrative therapy consisting of Western medicine (WM) and routine rehabilitation in ...conjunction with Chinese medicine (CM), such as acupuncture and Chinese herbal medicine. However, there is no available evidence on the effectiveness of the combined use of WM and CM interventions in stroke rehabilitation.AimsThe purpose of this meta-analysis is to evaluate the results of all individual studies to assess the combined use of CM and WM in stroke rehabilitation compared with WM only.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. MEDLINE, EMBASE, Cochrane and China National Knowledge Infrastructure (CNKI) were searched. The included outcomes were dependency, motor function, depression and swallowing function. Subgroup analysis was performed, and publication bias was assessed using funnel plots.Summary of review58 studies and 6339 patients were included in the meta-analysis. Subgroup analysis revealed that combined therapy comprising both acupuncture and WM had a superior effect on improving dependency and swallowing function compared with standard WM therapy alone. Potential superiority of combined therapy comprising CM and WM in improving depression compared with standard WM therapy was also found.ConclusionsOur results indicate that the combined use of CM and WM could be more efficacious in stroke rehabilitation compared with the use of WM therapy alone. However, most studies were short in duration (2 to 4 weeks) and prone to different types of biases, which prevents making any conclusion regarding the long-term effects and raises concerns regarding true efficacy in context of high likelihood of Hawthorn bias. So, more randomised controlled trials with more rigorous design and longer duration of treatment and follow-up need to be conducted to compare WM alone versus WM and CM combined.PROSPERO registration numberCRD42020152050.
The expansion of US doctoral research programs raises questions about mentorship capacity, program quality, and decisions about future expansion. To describe capacity issues and, when possible, ...compare findings to those of an earlier study, a survey of US nursing research doctoral programs (n = 105) was conducted in 2008. The response rate was 84.8%. The Web sites of non-responding schools were reviewed providing some data from all programs. The mean ratio of students per current externally funded grant was 6.9 (SD 7.5) to 1. The mean ratio of student to ever-funded faculty was 8.3 (SD 8.3) to 1. The mean number of research activities required (out of 5 possible) was 1.8 (SD 1.4), and the most common was a research practica (77%), followed by attendance at a research meeting external to the school (37%), and submitting an article for publication (32%). The quality of many programs may be compromised by capacity issues. Attention to existing programs' requirements and capacities and determination of the roles of these variables in producing research competitive graduates is needed.
Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education ...are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation.
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