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Background Transition to practice is a major concern for nurse educators, health care executives, and new nursing graduates. The disparity of nurse educators' and leaders' perceptions regarding new graduates' abilities to perform procedural skills may lead to patient harm. Pay for performance, quality indicators, and decreased reimbursement related to catheter-associated urinary tract infections have increased the need for competency validation. Methods A quantitative method with a descriptive correlational design provided information about the relationship of self-efficacy of the new nursing graduate and competency in urinary catheterization. Following a self-efficacy inquiry, a high-fidelity simulation was conducted for individual evaluation of the psychomotor skill of urinary catheterization. Results Analysis with nonparametric statistics for correlation indicated a lack of statistical significance (p > .05) between self-efficacy and competency in the psychomotor skill of urinary catheterization. Conclusions This study indicates that there is a need for validating competency in psychomotor skills within the context of a simulated patient care situation. The appropriate use of high-fidelity simulation may include incorporating self-efficacy measurements with an objective evaluation of psychomotor abilities to improve patient outcomes while increasing the accountability of the nurse.

The purpose of this focused review was to provide an overview of existing high-fidelity simulation reviews in undergraduate nursing education. ​Over the last 10 years, there has been a substantial increase in the use of high-fidelity simulation in undergraduate nursing education. Six reviewers conducted a systematic literature search on existing reviews of high-fidelity simulation and undergraduate nursing education from January 1, 2009, through June 30, 2015. Using a comprehensive search of literature databases and hand searches, a total of 34 reviews were initially selected for full review with seven reviews included in the final analysis after rereview of the inclusion/exclusion criteria. Findings from simulation research and reviews revealed significant differences in design and assessment methods leading to a wide variety of measurement outcomes and a variety of limitations. Of the seven reviews, five were integrative reviews and two were reviews of the literature. No meta-analysis or systematic reviews met the inclusion criteria. The review suggests a need for methodologically sound research that translates simulation outcomes to future performance and practice. Findings from the review support the multitude of challenges in simulation research including a lack of funding, a lack of simulation training for faculty and staff, and a lack of support for faculty conducting simulation research. Limitations of prior studies include weak designs, mixed samples, and a lack of valid and reliable evaluation tools.

Background This qualitative study examined baccalaureate minority nursing students' perceptions of high-fidelity simulation. Methods Three focus groups assigned by race were conducted in junior and senior students who have previously participated in high-fidelity simulation. Results Three themes and two subthemes emerged: a need to keep the peace, pressure to perform, and demographics as a factor in simulation with subthemes: isolation and discrimination and faculty role. Conclusions Results confirm that current simulation practices in nursing education may exist as barriers to minority students. Study findings will be used to develop and test interventions aimed at improving the educational experiences of minority students.

Objective To define the different breastfeeding interventions that promote breastfeeding exclusivity and duration in the late preterm infant and to synthesize findings from the published empirical literature on late preterm infant breastfeeding interventions. Data Sources The databases CINAHL, Scopus, and PubMed were searched for primary research articles on breastfeeding interventions for late preterm infants. Inclusion criteria included original research studies in which authors examined a breastfeeding intervention or second-line strategy in a sample inclusive of but not necessarily limited to the gestational age range of 34 to 36 6 7 weeks gestation, written in English, and published between 2005 and 2015. Study Selection Thirteen articles were identified, including five randomized controlled trials, three quasi-experimental studies, four descriptive studies, and one case study. Data Extraction Whittemore and Knafl's methodology guided this integrative review. Data extraction and organization occurred under the following headings: author and year, study design, level of evidence, purpose, sample, setting, results, limitations, recommendations, and intervention. Data Synthesis Studies on breastfeeding interventions were synthesized under four concepts within the Late Preterm Conceptual Framework: Physiologic Functional Status, Care Practices, Family Role, and Care Environment. Conclusion Most breastfeeding interventions within this integrative review had positive effects on exclusivity and duration of breastfeeding in the late preterm infant. However, second-line strategies had equivocal effects on exclusivity but had positive effects on duration. The positive effects of breastfeeding interventions on breastfeeding exclusivity and duration are highlighted in our results, and we point to the need for a focus on breastfeeding after the transition home for late preterm infants.

Advances in paediatric healthcare are often the result of randomised clinical trials.1,2 Notable examples include trials on vaccines,3 surfactant in preterm infants,4 and oncology.5 Researchers, healthcare providers, and parents acknowledge the importance of research, but effective recruitment into paediatric clinical trials remains a difficult task.6-9 Barriers to participation in paediatric research have been well described in the literature,10-16 but the literature on strategies for recruiting critically ill infants for clinical trials is limited.17-19 The concept of equipoise or the “uncertainty principle” can present challenges to recruitment in randomised controlled trials, especially when the study drug is routinely used in clinical practice.20 The ethical principle is upheld if there is true uncertainty about which trial arm is most likely to benefit the patient.20 Preconceived notions of efficacy on the part of the investigators should be discussed in advance to eliminate the lack of equipoise as a potential barrier to recruitment. The purpose of this report is to describe the key challenges for recruitment, the strategies implemented to address these challenges, and lessons learned from this experience. In the case of neonates with complex congenital cardiac diseases and functionally univentricular hearts, parents are under extreme stress when approached to participate in research, especially if the diagnosis was not made prenatally. Parents are mourning the loss of an expected “healthy child” and adjusting to the new realities of a child who will require multiple surgical and other procedures before 3 years of age. Appropriate practices and strategies of recruitment during this emotional time are key to engaging parents and their medical providers in a conversation about clinical research and securing successful enrolment of infants. In 2001, the Pediatric Heart Network was established by the National Heart, Lung, and Blood Institute, National Institutes of Health to conduct multi-centre clinical research in children with cardiovascular disease.21 After successful recruitment to an observational study22 and a randomised placebo-controlled drug trial in Kawasaki disease,23 the Pediatric Heart Network launched the “Angiotensin-Converting Enzyme Inhibition in Infants with Single Ventricle Trial” or the “Infant Single Ventricle Trial”.24,25 This double-blind, randomised placebo-controlled trial compared the effects of enalapril with placebo on somatic growth in 230 neonates with functionally univentricular hearts. After the “Infant Single Ventricle Trial” began, recruitment was more challenging than in previous studies and enrolment began to lag. Efforts to understand and remediate the problems were further complicated by the launch of the Pediatric Heart Network’s “Single Ventricle Reconstruction Trial”, a randomised surgical trial comparing two types of surgical shunts, in May, 2005,26,27 which recruited shortly after birth a subset of infants eligible for the “Infant Single Ventricle Trial”.

ObjectiveThe purpose of this analysis was to evaluate a novel strategy for reporting adverse events in the Pediatric Heart Network’s randomized surgical trial of systemic–pulmonary artery shunt versus right ventricle–pulmonary artery conduit in infants with hypoplastic left heart syndrome. The strategy was developed to align the reporting process with the needs of a surgical trial while maintaining participant safety.MethodsAdverse event reporting was analyzed for 2 groups of study subjects: those randomized to a trial arm during a period in which a standard adverse event reporting system was used (period 1) and those randomized after institution of a system that focused serious adverse event reporting on 6 sentinel events (period 2). The analysis encompassed the period from randomization (Norwood surgery) to hospital discharge from stage II surgery. Adverse event rates were compared using a Poisson regression model for the number of events per subject.ResultsFrom period 1 to period 2, the rate of serious adverse events requiring expedited reporting decreased as expected (0.42 vs 0.14/subject/month of follow-up; P

A critical component of the progression of a successful academic career is being promoted in rank. Early-career faculty are required to have an understanding of appointment, promotion, and tenure (APT) guidelines, but many factors often impede this understanding, thwarting a smooth and planned promotion pathway for professional advancement. This article outlines the steps taken by an APT committee to improve the promotion process from instructor to assistant professor. Six sigma's DMAIC improvement model was selected as the guiding operational framework to remove variation in the promotion process. After faculty handbook revisions were made, several checklists developed, and a process review rubric was implemented; recently promoted faculty were surveyed on satisfaction with the process. Faculty opinions captured in the survey suggest increased transparency in the process and perceived support offered by the APT committee. Positive outcomes include a strengthened faculty support framework, streamlined promotion processes, and improved faculty satisfaction. Changes to the APT processes resulted in an unambiguous and standardized pathway for successful promotion.

Many undergraduate students enter psychiatric mental health nursing with anxiety, fear, and negative attitudes related to the patient population and their complex care. This issue is further complicated by the unique learning needs of an increasingly diverse group of students who require innovative, multi-modal teaching strategies. Faculty strive to provide active learning strategies to help students practice mental health nursing skills within a safe and non-threatening environment. These educational interventions can further develop self-confidence in student nurses to provide safe and therapeutic nursing care. This article discusses integrating components of flipped classroom and active, team-based learning into an undergraduate psychiatric mental health-nursing course.

To describe neurodevelopmental outcomes in infants with single ventricle (SV) physiology and determine factors associated with worse outcomes.Neurodevelopmental outcomes for infants with SV enrolled in a multicenter drug trial were assessed at 14 months of age using the Bayley Scales of Infant Development-II. Multivariable regression analysis was used to identify factors associated with worse outcomes.Neurodevelopmental testing was performed at 14 ± 1 months in 170/185 subjects in the trial. Hypoplastic left heart syndrome was present in 59% and 75% had undergone the Norwood operation. Mean Psychomotor Developmental Index (PDI) and mental developmental index (MDI) were 80 ± 18 and 96 ± 14, respectively, (normal 100 ± 15, P.001 for each). Group-based trajectory analysis provided a 2-group model ("high" and "low") for height z-score trajectory and brain type natriuretic peptide (BNP) trajectory. The predicted PDI scores were 15 points higher in the "high" height z-score trajectory compared with the "low" cluster (P.001). A higher number of serious adverse events during the trial was associated with lower PDI scores (P = .02). The predicted MDI scores were 13-17 points lower in "low height trajectory-high BNP trajectory" group compared with the other 3 groups (P.001). MDI scores were also lower in subjects who required extracorporeal membrane oxygenation during the neonatal hospitalization (P = .01) or supplemental oxygen at discharge (P = .01).Neurodevelopmental outcome at 14 months of age is impaired in infants with SV physiology. Low height trajectory and high BNP trajectory were associated with worse neurodevelopmental outcomes. Efforts to improve nutritional status alone may not improve neurodevelopmental outcomes.