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This integrative review identified challenges for interprofessional home care and provided recommendations for improving geriatric home care. A search of six databases identified 982 articles; 11 of them met the review's eligibility criteria and were included in the review. Quality appraisal of the included studies was performed using two tools (Critical Appraisal Skills Program for Qualitative Research and Mixed Methods Appraisal Tool), and their overall methodological quality was found to be satisfactory. After applying D'Amour et al.'s framework, four "challenge" themes emerged: (1) lack of sharing, (2) lack of partnership, (3) limited resources and interdependency, and (4) power issues. Recommendations included providing practical multidisciplinary training guided by a standardized model, establishing streamlined communication protocols and a communication platform reflecting the actual needs of users by involving them in its design, and asking interprofessional team members to commit to home care planning and to cultivate a collaborative culture and organizational support.

Background: This scoping review examined the outcomes of accelerated second-degree baccalaureate and master of nursing programs using the Kirkpatrick four-level model. Method: A systematic search of four major scientific databases identified 15 articles meeting study inclusion criteria. The articles were assessed for educational outcomes, and extracted data were organized according to the four-level Kirkpatrick model consisting of reaction, learning, behavior, and results. Results: Both second-degree baccalaureate and master of nursing program students showed strong academic achievement, high employment rates, and high program satisfaction but reported lack of perceived preparedness for a clinical position. No studies evaluated the long-term impacts of the programs on graduates' clinical practice or patient outcomes. Conclusion: Accelerated second-degree nursing programs quickly and efficiently produce licensed nurses. The care provided by the graduates of these accelerated programs needs to be investigated in both short- and long-term to better determine overall program effectiveness. [ J Nurs Educ. 2021;60(5):265–271.]

People with type 1 diabetes (T1D) have personal strategies for maintaining euglycemia while exercising which generally serves them well during training. Their strategy often yields wildly differing results during a competition. The influence of competition stress (notably, epinephrine causing prompt elevations in glucose) and high-intensity and/or long-duration efforts can yield dysglycemia. Two different studies were conducted to observe this phenomenon. In a small study of subjects with T1D completing athletic competitions, perceived stress level as reported by the individual is insufficient for determination impact upon glycemia. An elevated heart rate during the competition over what was observed at the same running pace in training was a better indicator of an increase in glycemia. To recreate an athletic stress scenario in a clinical setting, 13 subjects with T1D completed a low intensity treadmill protocol for 3 sessions: non-stress, verbally reported mental math with an audience, and stressful video games to observe the influence on glycemia and heart rate. The treadmill protocol, prior meal, and insulin doses were matched for each individual for the 3 sessions. When compared to the non-stress treadmill session, an elevated average heart rate was observed in 10 of the 13 video game sessions and an elevated average glucose was observed in 9 of the 13 video game sessions. In the mental math sessions, an average heart rate elevated heart rate was observed in 6 of the 13 sessions with 7 of 13 having a higher average glucose compared to the non-stress session. While individual response to acute stress yields a high degree of intersubject variability, the video game sessions may more closely match the competition stress experienced and physiological response to stress observed during an athletic competition. The cause of the stressor may be critical in detection of stress and predicting glycemic response for the management of T1D. Disclosure N. Hobbs: None. M. Park: None. M. Chu: None. Y. Song: None. L.T. Quinn: None. M. Sevil: None. A. Cinar: Research Support; Self; Dexcom, Inc., JDRF. Stock/Shareholder; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S, Tandem Diabetes Care. Funding JDRF (A18-0036-001); National Institutes of Health (DP3DK101075, F31DK116524)

The effects of acute psychological stress, heart rate variability (HRV), an indicator of autonomic function and glycemic variability (GV) have not been extensively researched in type 1 diabetes (T1D). The aim of this study is to explore the effect of acute psychosocial stress on HRV and GV in people with T1D. Methods: Eleven participants with T1D (33.00 ± 11.25 years) participated in the study. To assess acute mental stress, the subjects 1) participated in the Trier Social Stress Test (TSST); and 2) played competitive video games (Nintendo Switch™). The TSST followed standardized procedures whereby stress was induced asking participants to provide a job talk and arithmetic in front of two judges. Participants played the Mario Kart to go-kart races (10 minutes) and rotated their controllers to untangle the Treasure Chest (10 minutes). Resting HRV and GV were obtained. The subjects wore a continuous glucose monitor and a Zephyr Bioharness™ to record GV and HRV, respectively. Nonparametric, paired samples T-tests were conducted using SPSS 24. Results: During TSST, there were significant differences between the resting and TSST testing period in the sympathetic nervous sympathetic nervous system index (.57 ± 1.33 vs. 1.36 ± 1.40; z = -2.845, respectively; p Conclusion: This study suggests that the TSST induced stress in people with T1D, increased sympathetic activity; however, the TSST did not change glycemic variability. Playing competitive video game did not appear to neither induces stress nor affected glycemic variability. The competitive video game did not cause stress compared to TSST. Disclosure M. Park: None. Y. Song: None. M. Chu: None. M. Sevil: None. N. Hobbs: None. L. Sharp: None. A. Cinar: Research Support; Self; Dexcom, Inc., JDRF. Stock/Shareholder; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S, Tandem Diabetes Care. L.T. Quinn: None. Funding JDRF

People with type 1 diabetes (T1D) have an increased risk for autonomic dysfunction and those with poorly controlled blood glucose levels have an increased risk for cardiovascular disease. The purpose of this study was to determine heart rate variability (HRV) and glucose variability (GV) parameters in less than optimally controlled patients (Group 2: A1C ≥ 7.0%, n = 6]) compared to well-controlled patients (Group 1: A1C ≤ 6.9% [n = 7]) during steady state treadmill exercise took and rest. Methods: Thirteen T1D participants, (32.42 ± 10.46 years), performed steady state treadmill exercise (40% VO2Peak) for 30 minutes. Prior to exercise, participants rested for 30-minutes for determination of resting HRV and GV. Participants wore continuous glucose monitors and a Zephyr Bioharness™ to determine GV and HRV, respectively. Nonparametric, paired samples T-tests were conducted using SPSS 24. Results: In group 2, there were significant differences between the resting period and treadmill exercise in the (1) root mean score of successive differences (RMSSD) (27.71 ± 13.43 vs. 8.01 ± 3.90; z = -2.201, respectively; p Conclusion: This study suggests that during steady state aerobic exercise, people with poorer glucose control exhibit a pattern of metabolic inflexibility; however, HRV decreased with steady state exercise in both groups suggesting that exercise training may help to normalize HRV in patients with poorly controlled glucose levels. Disclosure M. Park: None. M. Chu: None. Y. Song: None. M. Sevil: None. A. Cinar: Research Support; Self; Dexcom, Inc., JDRF. Stock/Shareholder; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S, Tandem Diabetes Care. L.T. Quinn: None. U.G. Bronas: None. Funding JDRF

High turnover contributes to the United States’ nurse shortage, particularly new graduate nurses’ (NGN) high rate of departure (27.6%) within their first year of practice. Low nursing competency is often responsible for NGNs’ high turnover rate. Although employer orientation programs develop NGNs’ hard skills (knowledge and performance), achieving satisfactory levels of soft skills (attitudes and behaviors) is also essential to NGNs’ competency and retention. However, the intangible nature of soft skills makes it difficult to evaluate. To address this issue, in Phase I, an integrative literature review explored NGNs’ self-assessed competencies. In Phase II, based on review findings and Benner’s framework “From Novice to Expert,” a qualitative descriptive study identified critical soft skills and developed behavioral indicators at four competency levels for each skill: beginning, developing, accomplished, and exemplary. In Phase I, a database search ultimately yielded 16 articles that were evaluated for quality. These articles provided descriptions of NGNs’ self-assessed competencies, classified as perceived strengths and weaknesses that informed the qualitative descriptive study. Purposeful sampling recruited 13 clinical nurse educators/preceptors from multiple units in one large hospital. One-on-one participant interviews were audio-recorded, transcribed, and subjected to direct content analysis using NVivo. Finally, the literature review and qualitative study findings were compared. Phase I findings revealed that NGNs’ self-assessed strengths focused on technical skills and clinical knowledge while their weaknesses focused primarily on soft skills: communication, teamwork, helping role, and professionalism. Phase II data analysis revealed five soft skill themes: personal growth, effective interaction, professionalism, teamwork, and caring role. Descriptors of four competency levels were derived for 20 subthemes. This study is the first to identify critical soft skills to be evaluated in NGNs. The study results provide a useful guide for academic and clinical nurse educators’ assessments of NGNs’ developing competencies. These assessments will promote improvement in NGN soft skill competencies and ultimately NGNs’ retention in practice. The end goal of this research is to apply the study findings to the construction of a clinical assessment rubric for soft skills in NGNs and other nurses.

Much of the ongoing shortage of nurses can be attributed to high turnover rates, and open positions are mostly filled by new graduate nurses who often lack the competencies required to provide quality patient care. An additional problem is that over 20% of these nurses leave their positions within 1 year, and low nursing competency is a main contributor to their decision. New graduate nurses' competencies are typically evaluated by experienced nurses who attempt to provide objective assessment of deficiencies, but this approach has not reduced turnover rates. Therefore, this integrative review explored new graduate nurses' self-assessed competencies. The review revealed that new graduate nurses' self-assessed deficiencies included advanced technical skills, critical thinking, communication, teamwork, helping role, and professionalism, most of which were associated with "soft" skills. New graduate nurses' possession not only of "hard" nursing skills within the cognitive and psychomotor domains but also of soft skills that mostly lie within the affective domain is vital to achieve higher retention rates. Because soft-skill competencies are problematic to objectively evaluate, recommendations include development and frequent application of a more objective measure such as a rubric, greater emphasis on soft skills in education, and supervised hands-on training in supportive practice settings.