Search

Midcareer faculty are the "keystone" of academia. Faculty in midcareer experience an increase or change in responsibilities and expectations as well as reduced support and mentorship usually extended to junior faculty. Nonetheless, midcareer can be an ideal time for re-evaluating and defining one's career path and taking advantage of leadership and service opportunities. Successful navigation of midcareer is essential to ensure nursing faculty remain in the academic setting, contribute to nursing science, and have a satisfying career. In this paper, we present strategies midcareer nurse faculty can consider to maintain balance and advance their careers even during challenging times. These strategies include appraising career goals, maintaining and expanding mentoring relationships, seeking and utilizing opportunities for leadership development, selecting service strategically to advance career goals, preparing for the unexpected, maintaining/expanding scholarly productivity, learning when to say yes or no, embracing lifelong learning, and improving visibility of one's work. • Midcareer is an ideal time to appraise career goals and expand mentoring. • Midcareer is an opportunity for leadership development and significant service. • Time management and selective collaborations improve productivity in midcareer. • Improved communication and visibility during midcareer may extend influence. • Embracing lifelong learning and expecting the unexpected help maintain productivity. [ABSTRACT FROM AUTHOR]

Preterm infants experience numerous stressors in the neonatal intensive care unit. Non-pharmacological interventions, including maternal comforting touch, reduce stress responses of preterm infants; however, the effects of clinician-administered comforting touch are unclear. The purpose of this integrative review was to synthesize findings from clinical trials to determine the effect of clinician-administered comforting touch on preterm infants' acute stress responses. Eligible clinical trials were published in English between 2001 and October 2021 and reported effects of clinician-administered comforting touch on acute stress responses in preterm infants. Thirty clinical trials were included. Researchers tested the effect of comforting static touch, massage, massage with kinesthetic stimulation, sensorial saturation, and Yakson. There was significant heterogeneity in study design, comparison condition, and context of intervention delivery. Results varied; some studies demonstrated efficacy of comforting touch in reducing acute stress responses and others showed no effect. Generally, comforting touch provided during stressful procedures was associated with lower stress responses compared to standard care and was an effective adjunct to other stress management strategies. However, comforting touch alone was insufficient for managing pain, especially during skin-breaking procedures. While comforting touch may be a useful part of stress management plans for preterm infants, additional research is needed to determine when comforting touch is appropriate and effective. Comforting touch is beneficial to preterm infants and should be provided for stress management. For highly intrusive or painful procedures, comforting touch can be provided as part of a comprehensive stress management plan. • Comforting touch helps decrease preterm infant stress responses. • Comforting touch could be an adjunct for pain relief during painful procedures. • Comforting touch is insufficient pain management for highly intrusive procedures. [ABSTRACT FROM AUTHOR]

The Developmental Psychobiological Model of Experiential Canalization (DPMEC) proposes that conditions of poverty-related adversity influence child self-regulation through parental caregiving, stress hormones, and the child's genetics. However, empirical findings investigating these relationships with prolonged stress hormones are mixed. Further, the relationships among conditions of adversity with prolonged stress hormones have seldom been investigated in toddlers living in poverty. Guided by the DPMEC, we examined the relationships among maternal caregiving, prolonged stress, and self-regulation in toddlers living in poverty in the United States, to include examining whether toddler prolonged stress mediated relations between maternal caregiving and child self-regulation. Participants were mothers and toddlers (20 to 24 months of age) living in poverty, who provided hair samples to measure four months of average cortisol concentration to estimate prolonged stress. We used observational measures to examine maternal caregiving and indirect report to measure children's self-regulation. Findings did not support the role of toddler prolonged stress in mediating the relationship between maternal caregiving and toddler self-regulation. However, multiple linear regression models showed that higher levels of maternal emotionally supportive caregiving significantly predicted better toddler soothability (b = 0.90; p =.03; 95% CI [0.10, 1.69]; partial correlation = 0.26). This study adds partial support for the DPMEC to represent associations between maternal caregiving and toddler self-regulation for mothers and toddlers experiencing poverty. While these data come from an observational study, pediatric nurses may consider assessing maternal supportive caregiving upon reports of poor toddler soothability. • We tested toddlers' stress hormones and self-regulation responses to adversity. • The sample comprised 94 mothers and toddlers living in poverty in the United States. • Toddler stress did not mediate parental caregiving and child self-regulation. • Toddlers had better soothability if mothers were more emotionally supportive. [ABSTRACT FROM AUTHOR]

This paper presents an analysis of Head Start (HStart) preschooler data by severity of developmental concern, while considering socio-demographic and other factors that highlight racial and ethnic disparities in the early identification of developmental delay or disability (DD). We conducted an analysis of 2014–2015 academic year data for preschool-aged children in HStart in both urban and suburban centers in a large Midwestern city. Descriptive statistics were used to determine the prevalence of developmental concerns and compare characteristics of children with mild-to-moderate versus severe developmental concerns; differences between groups were compared using t -tests and chi-square tests. Multivariate logistic regression was used to determine the independent effect of each predictor of concern severity. Nearly one-third of HStart preschoolers were identified with developmental concern; 70% were mild-to-moderate risk for DD and the remaining severe risk. Neither group was routinely referred to healthcare for evaluation or treatment, and most of the severe risk group did not qualify nor receive treatment for DD with an Individualized Education Plan. Suburban and urban preschoolers with severe concern were less likely to be African American or Latinx, suggesting that racially and ethnically diverse preschoolers in HStart may be under-identified and under-treated. Lags in the educational diagnosis of DD may mirror the disparities in diagnosis and treatment of DD among minority groups. Primary care is the first line for detection and treatment of DD, and offers a unique opportunity to act for racially and ethnically diverse HStart preschoolers disproportionately at-risk for DD. • Nearly 1/3 of Head Start preschoolers were identified with concern for developmental delay or disability • None of those at-risk for developmental delay or disability were routinely referred for healthcare evaluation or treatment • African American and Latinx preschoolers were most at-risk for delayed identification and treatment for developmental delay • Primary care partnering with Head Start can speed early diagnosis for minority preschoolers at-risk for developmental delay [ABSTRACT FROM AUTHOR]

Chronic diseases, such as opioid use disorder (OUD) require a multifaceted scientific approach to address their evolving complexity. The Council for the Advancement of Nursing Science's (Council) four nursing science priority areas (precision health; global health, determinants of health, and big data/data analytics) were established to provide a framework to address current complex health problems. To examine OUD research through the nursing science priority areas and evaluate the appropriateness of the priority areas as a framework for research on complex health conditions. OUD was used as an exemplar to explore the relevance of the nursing science priorities for future research. Research in the four priority areas is advancing knowledge in OUD identification, prevention, and treatment. Intersection of OUD research population focus and methodological approach was identified among the priority areas. The Council priorities provide a relevant framework for nurse scientists to address complex health problems like OUD. • Priorities: Precision Science, Data & Analytics, Health Determinants, Global Health. • Priority areas research is advancing knowledge in opioid use disorder. • CANS priorities provide a relevant framework to address complex health problems. • CANS provide rich and varied viewpoints to inform nursing scientific priorities. [ABSTRACT FROM AUTHOR]

• IDPs can serve as a mentoring tool that stimulates conversation, facilitates the provision of feedback on goals and achievement of milestones. • Although IDP formats varied across NINR-funded T32s, common areas included engaging in self-assessment, identifying professional/career goals, and stating strategies and tactics to achieve these goals. • Challenges included creating a culture where IDP use is understood and valued. • Data from IDPs can be collated for outcome evaluation and for quality improvement of T32s and academic programs that prepare nurses for scientific careers. [ABSTRACT FROM AUTHOR]

• The population of children is growing along with an increase in complexity and diversity of health care needs. • The number of pediatric nurse scientists is inadequate to meet the demand for research underlying evidence-based care for this growing pediatric population. • Pediatric nurse scientists develop from pediatric nurses, and the number of pediatric nurses is steadily decreasing. • Nursing leaders in academia, practice, and public policy must act to support and build pediatric nursing and pediatric nursing science. The provision of safe and effective nursing care to children is dependent upon pediatric nurse scientists creating knowledge that guides and directs day-to-day nursing practice. Current trends demonstrating steady decreases of pediatric nurses and inadequate numbers of PhD-prepared pediatric nurse scientists put the health of our children at risk. The purposes of this paper are to (1) summarize current health care demands in pediatrics, (2) present our concern that the number of pediatric nurse scientists is inadequate to generate foundational knowledge to guide pediatric nursing practice, (3) present our perspectives on factors influencing the number of pediatric nurse scientists, and (4) recommend specific actions for nursing leaders, nursing faculty, and professional nursing organizations to increase the depth and breadth of pediatric nursing science to meet current and future pediatric care needs. [ABSTRACT FROM AUTHOR]

Telomere length (TL), a biomarker of cellular aging, is influenced by adverse life experiences. Although depression and anxiety are associated with shorter TL in adults, the relationship in younger ages has received little attention. We examined relationships between depression and anxiety diagnoses and symptomatology and TL in adolescence, an important developmental window for early intervention. Sex differences in relationships were also examined. Wave 1 survey and TL data from the Adolescent Health and Development in Context study were analyzed (N = 995). Depression and anxiety diagnosis were parent-reported measures categorized as: current diagnosis, prior diagnosis, and never diagnosed (reference category). Depressive symptoms were measured via adolescent-report using nine items from the Center for Epidemiologic Studies-Depression scale, short form. Anxiety symptoms were measured via adolescent-report using eight items from the pediatric anxiety scale obtained from the Patient-Reported Outcomes Measurement Information System. Genomic DNA was isolated from 500 μL saliva via ethanol precipitation. Genomic DNA TL was assessed using monoplexed quantitative polymerase chain reactions. Relative T/S quantities were calculated in accordance with established procedures. Covariates included sociodemographic factors (sex, age, race/ethnicity, caregiver marital status and education level, and household income), pubertal development, and season of collection. Descriptive and multivariable linear regression analyses were conducted, including an examination of sex as a moderator in the relationships between depression, anxiety, and TL. In multivariable analysis, adolescents with a current depression diagnosis (b = −0.26, p <.05), but not a prior diagnosis (b =0.05, p >.05) had shorter TL than those who were never diagnosed; higher depressive symptom scores were associated with shorter TL (b = −0.12, p <.05). No significant associations were found between anxiety diagnosis and TL; however, higher anxiety symptom scores were associated with shorter TL (b = −0.14, p <.01). Sex did not significantly moderate any of the relationships between depression, anxiety and TL. Depression and anxiety were associated with shorter TL in this diverse community sample of adolescents and the findings highlight the potential for impaired mental health to contribute to cellular senescence as early as adolescence. Prospective research on the long-term effect of depression and anxiety occurring earlier in the life span on TL over time is needed, including examination of potential mechanisms that may accelerate or buffer the negative effects of impaired mental health on TL. • Current diagnosis of depression, but not anxiety associated with shorter TL. • Greater depressive and anxiety symptoms associated with shorter TL. • Sex did not moderate associations between depression or anxiety and TL. [ABSTRACT FROM AUTHOR]

• Including newer data approaches can improve precision health decisions. • Omics in research may lead to better assessment and management to improve care. • Electronic sensors allow real-time monitoring of behavior and biology in research. • Geospatial data provide an important lens to improve precision health approaches. • Broader understanding of the complexity of human health and illness will inform health care policy. Precision health can provide an avenue to bridge and integrate ways of knowing for research and practice. Nurse scientists have a long-standing interest in using multiple sources of information to address research questions of significance to the profession and discipline of nursing, which can lead to much needed contributions to precision health care. In this paper, nursing scientists discuss emerging research methods including omics, electronic sensors, and geospatial data, and mixed methods that further develop nursing science and contribute to precision health initiatives. The authors provide exemplars of the types of knowledge and ways of knowing that, using these and other advanced data and analytic strategies, may advance precision health within the context of nursing science. [ABSTRACT FROM AUTHOR]

Highlights • Pragmatic clinical trials (PCTs) are challenging to describe in a manuscript for publication. • Manuscripts must capture clinical context and intervention sustainability. • Guidelines and tools are available for preparing a manuscript describing a PCT. • Dissemination is critical to understand intervention effects in real-world settings. Abstract Background Pragmatic clinical trials (PCTs) are an important research approach for nurse researchers seeking to bring efficacious interventions to the real world of clinical practice. These approaches take into account the complex and often messy conditions of clinical care, involving patients with comorbid conditions, many providers providing the intervention, and limited evaluation data with which to judge effectiveness. Purpose The purposes of this paper are to describe the challenges for PCT manuscript writer and to review the various guidelines that may be used to assist in manuscript development. Discussion Describing the design and results of a PCT in a manuscript for publication is challenging due to the complexity and unique context of these important trials. Guidelines and other resources are available to assist researchers in preparing manuscripts reporting PCTs. [ABSTRACT FROM AUTHOR]

Missed nursing care is an emerging measure of front-line nursing care effectiveness in neonatal intensive care units (NICUs). Given Magnet® hospitals' reputations for nursing care quality, missed care comparisons with non-Magnet® hospitals may yield insights about how Magnet® designation influences patient outcomes. The purpose of this secondary analysis was to evaluate the relationship between hospital Magnet® designation and 1) the occurrence of nurse-reported missed care and 2) reasons for missed nursing care between NICU nurses employed in Magnet® and non-Magnet® hospitals. A random sample of certified neonatal intensive care unit nurses was invited to participate in a cross-sectional survey in 2012; data were analyzed from nurses who provided direct patient care ( n = 230). Logistic regression was used to model relationships between Magnet® designation and reports of the occurrence of and reasons for missed care while controlling for nurse and shift characteristics. There was no relationship between Magnet® designation and missed care occurrence for 34 of 35 types of care. Nurses in Magnet® hospitals were significantly less likely to report tensions and communication breakdowns with other staff, lack of familiarity with policies/procedures, and lack of back-up support from team members as reasons for missed care. Missed nursing care in NICUs occurs regardless of hospital Magnet® recognition. However, nurses' reasons for missed care systematically differ in Magnet® and non-Magnet® hospitals and these differences merit further exploration. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this analysis was to measure changes in preterm infant feeding skill between discharge and two weeks post-discharge. Data were from 2 samples—22 preterm infants who participated in a non-experimental study of feeding readiness and 63 preterm infants who participated in a study of four oral feeding approaches. Both studies were approved by the institutional review board; parents gave informed consent. The Early Feeding Skills Assessment was used to measure feeding skills. Data were analyzed descriptively and by analysis of variance and regression. Analysis revealed that feeding skills changed selectively from discharge to post-discharge and that discharge skills were predictive of post-discharge skill. Changes that occur in feeding skills during the immediate post-discharge period have received little attention from researchers. The findings suggest that enhanced predischarge assessment and parent teaching maybe necessary to reduce reported parental stress associated with feeding the newly discharged infant and to promote a positive feeding experience. [Copyright &y& Elsevier]

Abstract: This longitudinal study of maternal responsiveness included a sample 23 mothers of preterm infants. The mothers completed questionnaires at three intervals: 2 weeks postpartum, 2 weeks after the infant''s discharge from the neonatal intensive care unit, and 3 months postpartum. Factors that have a potential effect on maternal responsiveness including postpartum depression, social support, stressors, self-esteem, maternal well-being, and maternal attitude were also examined. There were no significant changes in these variables or in maternal responsiveness over time. Social support and self-esteem were found to have a significant positive relationship with maternal responsiveness. Stressors had a significant inverse relationship with maternal responsiveness. There were no significant relationships between maternal well-being, postpartum depression, and maternal attitude about being a mother and maternal responsiveness. The findings suggest that although maternal responsiveness may be stable over time, it may be associated with other characteristics of the mother that need to be assessed. [Copyright &y& Elsevier]

Abstract: Purpose: The purpose of this study was to explore mothers’ perceptions of their experiences in feeding their preterm infants in the early weeks after hospital discharge. Subjects: Twenty-seven mothers whose preterm infants were part of a larger study of feeding readiness participated. Design: A qualitative, descriptive approach was used to explore mothers’ experiences in feeding their preterm infants after hospital discharge. Methods: A convenience sample of mothers of preterm infants were interviewed 2 to 3 weeks after hospital discharge. Data were generated by semi-structured interview and analyzed by searching for thematic patterns in the data. Mothers were asked to describe their experiences feeding their infants, their perceptions of how their infants’ feeding ability had changed since discharge, and the meanings they gave to these changes. The interviews were audiotaped and transcribed. Agreement of themes between the investigators was achieved. Main Outcome Measures: Three themes emerged from the interviews: interpreting infant behaviors, managing the feeding process, and realizing knowledge gaps. Principal Results: Mothers struggle with infant feeding in the first few weeks after discharge and experience a period of transition before comfort develops. Conclusions: Nursing interventions should include anticipatory guidance to mothers about feeding their infants after discharge and more concrete information regarding infant cues of hunger and satiation. Follow-up visits after discharge should include a review of the current feeding regimen, information regarding feeding progression, and reinforcement about changing infant behaviors as the preterm infant approaches 40 weeks postmenstrual age. [Copyright &y& Elsevier]

Abstract: A nonexperimental study with a sample of 95 preterm infants was used to develop a model of feeding performance outcomes (proficiency, percent of prescribed volume consumed, and efficiency) using feeding readiness indicators (morbidity, maturity, behavior state at feeding start, and feeding experience). All readiness indicators were related to each other. In particular, there was a strong relationship between maturity and feeding experience. Morbidity only had an effect on efficiency; the most ill infants were less efficient feeders. Behavior state affects all feeding outcomes in a linear fashion; more awake and alert infants had better feeding performance outcomes. The effect of experience and maturity on the outcomes is more complex because of the relationship between the two. Experience has a greater effect as the infant matures, and as the infant matures, the amount of experience increases. Successful feeding requires maturity as well as experience. [Copyright &y& Elsevier]

Abstract: A feeding study conducted at a tertiary care center''s neonatal intensive care unit tested a predictive model of bottle-feeding readiness and feeding outcomes. The study examined how bottle-feeding experience influences both bottle-feeding readiness and outcomes. The clinical coordinator played an integral role in the success of the research by coordinating the education of nurses, data collectors, and families; communicating with various interest groups; managing recruitment, enrollment, and participant tracking; and overseeing data collection. [Copyright &y& Elsevier]

Background: Preterm infants are at risk for impaired neurodevelopment. Inflammation may be an important modifiable mediator of preterm birth and neurodevelopmental impairment, but few studies have examined longitudinal measures of inflammation.Objective: To determine the relationship between longitudinal measures of inflammation and neurobehavior in very preterm infants.Study Design: Non-experimental, repeated measures cohort study.Methods: Very preterm infants were enrolled between October 2017 and December 2018. Blood was collected weekly until 35 weeks post-menstrual age for the quantification of plasma cytokines. Neurobehavior was assessed at 35 weeks post-menstrual age using the cluster scores for motor development and vigor and alertness/orientation from the Neurobehavioral Assessment of the Preterm Infant. Multiple linear regression models with robust standard errors were used to analyze the data. Average levels of individual cytokines, cytokine trends, and composite scores were used as measures of inflammation.Results: Seventy-three infants were enrolled in the study. Interleukin-1 receptor antagonist was associated with motor development and vigor scores. Interleukin-6 was associated with alertness/orientation scores. Tumor necrosis factor-alpha and composite scores of inflammation were associated with motor development and vigor and alertness/orientation scores. There were interactions with post-menstrual age at birth and infant sex.Conclusion: Inflammation may be an important predictor of short-term neurobehavior in preterm infants. Interleukin-1 receptor antagonist, interleukin-6, and tumor necrosis factor-alpha are key cytokines for studies of preterm infants, but composite scores may be a better measure of inflammation than individual cytokines. Inflammation can be damaging to the immature brain and may be a specific target for future interventions to improve outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this study was to test a coding system, the Maternal–Infant Synchrony Scale (MISS), for assessing synchrony of feeding interaction between a mother and her preterm infant. The secondary aim was to describe mother and preterm infant synchrony during feeding and the change over time. Methods: A descriptive, longitudinal design using data collected during an earlier study was employed, using a sample dataset from 10 mother–infant dyads that completed three data collection points. The Noldus Observer XT 8.0 (Noldus Information Technology b.v., 2006) was used for data review and coding. The MISS was created from pilot data and definitions further refined. The frequency of occurrence for select behaviors and the percentage of time behaviors occurred during the feeding and the changes in behaviors over the three observations periods were calculated. Results: The synchrony tool developed in this study demonstrates that changes occur in mother and infant behavior over time. Mothers were attentive and focused during feedings and monitored their infants’ sucking intently but there was little interaction between the dyad. Infant attempts at interaction were greater than the mother attempts to engage her infant. The influence of infant maturation on feeding behaviors was evident across observations. Conclusion: This study revealed behaviors that are descriptive of the interaction and can be used to develop interventions that would support the developing relationship. Use of the MISS with a larger sample size and a cohort of healthy, term newborns is needed to establish the MISS as a valid and reliable measure of synchrony. [Copyright &y& Elsevier]

Black-White disparities in physiological stress during adolescence are increasingly evident but remain incompletely understood. We examine the role of real-time perceptions of safety in the context of everyday routines to gain insight into the sources of observed adolescent racial differences in chronic stress as measured by hair cortisol concentration (HCC). We combined social survey, ecological momentary assessment (EMA), and hair cortisol data on 690 Black and White youth ages 11–17 from wave 1 of the Adolescent Health and Development in Context (AHDC) study to investigate racial differences in physiological stress. Individual-level, reliability-adjusted measures of perceived unsafety outside the home were drawn from a week-long smartphone-based EMA and tested for association with hair cortisol concentration. We observed a statistically significant interaction (p <.05) between race and perceptions of unsafety. For Black youth, perceived unsafety was associated with higher HCC (p <.05). We observed no evidence of an association between perceptions of safety and expected HCC for White youth. For youth who perceive their out-of-home activity locations to be consistently safe, the racial difference in expected HCC was not statistically significant. At the high end of perceived unsafety, however, Black-White differences in HCC were pronounced (0.75 standard deviations at the 95th percentile on perceived unsafety; p <.001). These findings call attention to the role of everyday perceptions of safety across non-home routine activity contexts in explaining race differences in chronic stress as assessed by hair cortisol concentrations. Future research may benefit from data on in situ experiences to capture disparities in psychological and physiological stress. • Black adolescents have substantially higher levels of hair cortisol concentration than White adolescents. • Real-time perceived unsafety is positively associated with hair cortisol concentration for Black youth, but not White youth. • At high levels of average perceived unsafety, racial differences in hair cortisol concentration are pronounced. • At low levels of perceived unsafety, we observe no statistically significant racial difference in hair cortisol. [ABSTRACT FROM AUTHOR]

Background: A first step to advance stress science research in young children is understanding the relationship between chronic stress in a mother and chronic stress in her child. One non-invasive measure of chronic stress is hair cortisol. However, little is known about strategies for hair sampling in mother-toddler dyads living in low-income homes in the U.S. To address prior limitations, the purpose of this study was to understand the feasibility of sampling hair for cortisol analysis in mother-toddler dyads living in low-income homes in the U.S. We examined feasibility related to participation, eligibility, and gathering an adequate hair sample weight.Methods: We approached 142 low-income, racially diverse, urban-dwelling mothers who were participating in an ongoing longitudinal birth cohort study for informed consent to cut approximately 150 hairs from the posterior vertex of their scalp and their toddlers' (20-24 months) scalp. We demonstrated the process of sampling hair with a hairstyling doll during home visits to the mother and toddler using rounded-end thinning shears.Results: Overall, 94 of 142 mother-toddler dyads (66 %) participated in hair sampling. The most common reason for participation refusal was related to hairstyle. All but three hair samples were of adequate weight for cortisol extraction.Discussion: The findings from this study can help researchers address sampling feasibility concerns in hair for cortisol analysis research in mother-toddler dyads living in low-income homes in the U.S. [ABSTRACT FROM AUTHOR]