Peering into the Post-COVID Nursing Curriculum

Peering into the Post-COVID Nursing Curriculum

Nursing education after COVID will rely more on technology and digital tools than ever. Simulation and online learning will be part and parcel of the curriculum for nursing students. It will also be more competency-based as the new AACN Essentials further integrate into nursing curriculums.

But what about the content of the curriculum?

Nursing education, according to Mary Dolansky, Ph.D., RN, FAAN, Sarah C. Hirsh Professor, Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school, may include instruction on telehealth, an emphasis on systems thinking, stress on leadership, and a focus on innovation and design thinking.

Nursing education after COVID

Mary Dolansky, Ph.D., RN, FAAN, is a Sarah C. Hirsh Professor at the Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school

A Look at Nursing Education After COVID

Telehealth

Understanding how to use telehealth in nursing is key, according to Dolansky. The Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, developed a series of four modules on telehealth so that all students received a basic foundation in telehealth nursing, including telehealth presence. It included teaching on using Zoom or the phone to assess and evaluate patients. She notes that interactive products that give students a feel for how such interactions occur and practice them can provide an excellent education.

Systems Thinking

Another aspect of post-COVID nursing education involves systems thinking, says Dolansky. This involves “really getting students to think beyond one-to-one patient care delivery and about populations. We need to create more curricula for nurses out in primary care sites and nurses out in the community, and that has not been a strong emphasis in schools of nursing. Instead, we focus mainly on acute care.”

More specifically, students should learn, for instance, how to use data registries to look at areas of patient need. One COVID example, notes Dolansky, would be to use registries to identify long-term COVID patients. Another could be to use a registry or database to discover what patients have followed up on their chronic disease since, during COVID, many patients stopped visiting healthcare providers.

Emphasizing Leadership

In the post-COVID curriculum, developing leadership skills may become more critical. “What we observed in the COVID crisis,” says Dolansky, “was an opportunity for nurses to stand up and speak out more. We were the ones at the frontline and had the potential to be more innovative and responsive. Many great nurses did step up and speak up, but we need to ensure that every nurse can speak up for patients in future crises or even advocate for our patients now. Nurses can be the biggest advocates for patients.”

Every school of nursing probably has a leadership course, Dolansky notes. But ensuring that there are case studies from COVID as to how nurses did stand up and speak out and how that made a difference would be a fundamental curriculum change.

“We want to prepare our students that you will be a leader and you will be on TV talking about how you are innovating and adapting to the changing needs of the health of our population. And COVID was a great example for that.”

Innovation

Post-COVID, nursing education needs to help students with innovation and design thinking, notes Dolansky. Over the past 10 years with QSEN, “what we’re trying to advocate is shifting the lens of a nurse from direct patient care delivery, which has been the focus of nursing, to shifting a little bit to systems thinking.”

Critical thinking, notes Dolansky, focuses on making decisions for an individual patient. Design thinking and innovation are more about “looking at the system in which we work and empowering the nurses to fix the systems. This is key to quality and safety, but it’s also key to the need for our nurses to contribute strongly to the health of the future population. They have to be at the table to respond to these crises. We need them to have the skill set of being a leader, standing up, being at the table and when they’re at the table, having ideas, being creative, and knowing how to test them. And having the technical skills to use the technology is probably where most of the solutions will be for the future.”

QSEN and Competencies

With the latest AACN Essentials, there is a drive for competencies in nursing education, notes Dolansky. The Essentials: Core Competencies for Professional Nursing Education, approved by the AACN in April 2021, calls for a transition to competency-based education focusing on entry-level and advanced nursing practice.

While revising the Essentials began before the pandemic, the experiences and learnings from the pandemic greatly impacted the work, notes a recent article in Academic Medicine. As a result, the Essentials includes population health competencies that specifically address disaster and pandemic response and will better prepare the next generation of nurses to respond safely in future events, the article says.

Now, a crosswalk has developed between QSEN competency statements and the 2021 AACN Essential Statements, notes Dolansky. However, she notes that the AACN is taking the QSEN foundation and moving it forward, stating to the public that “the nursing profession has these competencies that are providing safe quality care to the public.” Since 2012, the QSEN effort has been based on the Frances Payne Bolton School of Nursing.

“Own Their Competency”

In the culture of nursing education, students now need to be educated to “own their competency,” says Dolansky. “Students will see that competency development is part of their lifelong professional development.

Vanderbilt Launches Leadership Program for Diverse New Nurse Leaders and Faculty

Vanderbilt Launches Leadership Program for Diverse New Nurse Leaders and Faculty

Vanderbilt University School of Nursing created a new leadership development program for nurses new in health care leadership and academic positions who are from groups historically underrepresented in nursing and/or those who support them. The Academy for Diverse Emerging Nurse Leaders will be held in Nashville from November 14-18. Applications for the inaugural class of fellows are now being accepted.

“The need for nursing faculty and nurse leaders from groups historically underrepresented in nursing is well established, but research shows a need for career development resources that address the specific needs and challenges of diverse nurse leaders,” says Pamela Jeffries, PhD., FAAN, ANEF, FSSH, dean of Vanderbilt School of Nursing. “We believe that the knowledge, mentorship, strategy, and skills that new leaders will attain via the Academy for Diverse Emerging Nurse Leaders will empower them to continue to advance and lead.”

VUSN Associate Dean for Diversity, Equity and Inclusion Rolanda Johnson and Vanderbilt University Medical Center Senior Director for Nurse Diversity and Inclusion Mamie Williams will co-direct the academy, designed for nurses who have been in academic or health care leadership roles for less than three years.

“What makes this fellows program different from other professional development opportunities is that it incorporates and builds on the lived experiences of diverse faculty and health care leaders who have navigated a similar leadership path,” says Johnson. “It explores the challenges of being a leader from an underrepresented group as well as the challenges of supporting and expanding diversity in nursing leadership.”

Academy for Diverse Emerging Nurse Leaders

Academy for Diverse Emerging Nurse Leaders

Academy for Diverse Emerging Nurse Leaders

The academy is taught by experienced faculty and health care leaders from diverse backgrounds and is specifically designed to serve the needs of new and emerging nurse leaders and faculty. In addition to the initial five-day, in-person meeting, fellows will also participate in virtual sessions, receive mentorship from an executive coach and institutional mentor and develop a leadership project.

Williams said that the idea for the academy resonated with her as she thought about her own nurse leadership journey of more than 25 years. “This leadership academy, based on specialized education, discussions, and interactions with peers and diverse nurse leaders, affords the emerging leader an opportunity to thoughtfully design their leadership journey,” she says.

She and Johnson said the academy was developed to help new nursing faculty and new nurse leaders build skills, gain knowledge, and build a network of colleagues and mentors to help them advance their careers and mentor other emerging nurse leaders.

Applications for the first cohort of the Academy for Emerging Diverse Nurse Leaders are now open and available at https://redcap.link/cwgjy0w2. For more information and details on the academy, visit nursing.vanderbilt.edu/academy.

Melanoma in People of Color: What’s the Risk—and Will Sunscreen Help? A Black Dermatologist Explains

Melanoma in People of Color: What’s the Risk—and Will Sunscreen Help? A Black Dermatologist Explains

Melanoma is a potentially deadly form of skin cancer that effects people of every racial and ethnic group. The risk factor most closely linked to developing melanoma is exposure to ultraviolet, or UV, rays from the sun. In fact, sunburns have been associated with doubling one’s risk of melanoma.

Sunscreen can block UV rays and therefore reduce the risk of sunburns, which ultimately may reduce the risk of developing melanoma. Thus, the promotion of sunscreen as an effective melanoma prevention strategy is a reasonable public health message.

But while this may be true for light-skinned people, such as individuals of European descent, this is not the case for darker-skinned people, such as individuals of African or Asian descent.

The public health messages promoted by many clinicians and public health groups regarding sunscreen recommendations for dark-skinned people is not supported by the available evidence. Media messaging exacerbates the problem with headline after headline warning that Black people can also develop melanoma and that Black people are not immune.

To be sure, they can get melanoma, but the risk is very low. In the same way, men can develop breast cancer, however, we do not promote mammography as a strategy to fight breast cancer in men.

This message is important to me as a Black board-certified dermatologist and health services researcher at Dell Medical School at the University of Texas at Austin, where I am director of the pigmented lesion clinic. In this capacity I take care of patients at high risk for melanoma.

Melanoma in Black people is not associated with UV exposure

In the U.S., melanoma is 30 times more common among white people than Black people.

In Black people, melanoma usually develops in parts of the body that are not exposed to the sun, such as the palms of the hands and soles of the feet. These cancers are called “acral melanomas,” and sunscreen will do nothing to reduce the risk of these cancers.

When was the last time you had a sunburn on the palms or soles? Even among white people, there is no relationship between sun exposure and the risk of acral melanomas. Famously, Bob Marley died from an acral melanoma on his big toe, but sunscreen would not have helped.

Last year my research group conducted a systematic review in which we analyzed all of the published medical literature related to UV exposure and melanoma in people of color. This includes those of African, Asian, Pacific Islander, Indigenous and Hispanic descent. Of the 13 studies that met our criteria for inclusion, 11 showed no association between UV exposure and melanoma.

Among the two studies that showed an association, one study showed a positive association between melanoma and UV exposure in Black men. But that same study also examined UV exposure and melanoma in other groups, including Black women, white men and women and Hispanic men and women. In these other groups the researchers found no association between UV exposure and melanoma. This is a surprising result, given that white people are the group in which the association between UV exposure and melanoma has been consistently demonstrated, calling into question the validity of the study results.

The other study showing an association between UV and melanoma was among Hispanic men in Chile based on latitude within the country. A major caveat to this study is that the city with the highest number of melanomas is also home to a large population of Chileans of Croatian descent, who would not be considered people of color.

Unfortunately, none of these studies measured melanin concentrations of individuals, so it is not possible to know whether theoretically lighter-skinned people of color may be at risk for UV-associated melanoma. However, even in light-skinned East Asian individuals, there is no evidence that UV exposure is linked to melanoma.

The bottom line is that the link between UV exposure and melanoma in people of color has been studied many times over and has yielded little to no evidence of a connection. The Conversation

Racial disparities in melanoma outcomes are not related to UV exposure

Many dermatologists often point out that Black patients tend to show up to the doctor with later-stage melanoma, which is true. However, this is an issue of access and awareness and has nothing to do with sunscreen application or protection from the sun. Black people should be aware of growths on their skin and seek medical attention if they have any changing, bleeding, painful or otherwise concerning spots, particularly on the hands and feet.

However, the notion that regular application of daily sunscreen will reduce an already extremely rare occurrence is nonsensical.

UV radiation does affect dark skin and can cause DNA damage; however, the damage is seven to eight times lower than the damage done to white skin, given the natural sun-protective effect of increased melanin in darker skin.

To be clear, using regular sunscreen may help with reducing other effects of the sun’s rays such as sunburns, wrinkling, photoaging and freckling, which are all positive. But for the average Black person, sunscreen is unlikely to reduce their low risk of melanoma any further.

If sunscreen were important in the prevention of melanoma in dark-skinned patients, then why have we never heard of an epidemic of melanoma in sub-Saharan Africa, a region with intense sun, a lot of Black people and little sunscreen?

In certain subpopulations of Black people, such as those with disorders causing sun sensitivity, or patients with albinism – a condition in which people produce little or no melanin – or those with suppressed immune systems, sunscreen use may reduce risk of melanoma. But if you don’t fall into one of these categories, any meaningful risk reduction from the application of sunscreen is unlikely.

One-size-fits-all public health messaging misses the mark

Many dermatology and skin cancer-focused organizations – a few of which I belong to – promote the public health message of sunscreen use to reduce melanoma risk among Black patients. However, this message is not supported by evidence. There exists no study that demonstrates sunscreen reduces skin cancer risk in Black people. Period.

This issue of regular sunscreen use in Black people was made even more pressing after the release of two recent studies on sunscreen absorption in the Journal of the American Medical Association. This study showed that significant amounts of certain chemical sunscreen ingredients can get in the blood when used at maximal conditions, with unknown impacts on human health.

To me, the most shocking part of the studies were that most of the participants were Black, the group least likely to derive any meaningful associated health benefits from sunscreen, while being exposed to potentially harmful levels of chemicals.

As dermatologists and public health advocates, we can improve how we educate patients and the public about melanoma prevention without promoting public health messages that are grounded in fear and lack evidence. Black people should be informed that they are at risk of developing melanoma, but that risk is low.

Any dark-skinned person who develops a new, changing or symptomatic mole should see a doctor, particularly if the mole is on the palms or soles. We don’t know what the risk factors are for melanoma in Black or dark-skinned people, but they certainly are not UV rays.

This is an updated version of a piece that was published on May 14, 2019.

A Life in Caring: Native American Nurse Joanne Campbell Passes Away at 91

A Life in Caring: Native American Nurse Joanne Campbell Passes Away at 91

Joanne Campbell, RN, PHN passed away peacefully on June 21 after a 5-year battle with pancreatic cancer at the age of 91.

Joanne Marilyn Ross CampbellJoanne Marilyn Ross Campbell:

June 11, 1931 – June 21, 2022.

Joanne was born at home in Lakeport, California, on June 11, 1931, to Joseph and Anna (Santos) Ross. Soon after, Joanne and family moved to their beloved ranch on Big Valley Road in Finley, California. It was a place where she fondly remembered growing up in the family’s orchards surrounded by siblings Kenneth, Leona (Newman), Lois (Thorne), and Judith (Davidson). She and her sisters also comprised the entire choir at St. Mary’s Church in Lakeport with Joanne eventually taking over piano duties as well.

Joanne, always the stellar student, graduated school in Lakeport at the top of her class receiving a Doyle Scholarship to attend Santa Rosa Junior College. It was there she started her career with a pre-nursing program, graduating in 1952. Upon graduation, she was accepted at both Stanford University and the University of California San Francisco (UCSF) nursing schools, choosing UCSF for practical reasons — she would graduate 6 months earlier than the Stanford program with both RN and PHN (Public Health Nurse) degrees. She graduated in 1955. At the end of her nursing internship, she attended a 6-month position at the Queen’s Hospital of Nervous Diseases in London, which began in 1958. This would lead to her lifetime passion for traveling. After the internship, she joined three of her eventual lifelong friends in a Volkswagen bug and toured Europe for 6 months—it was the trip of her life. Upon her return, she turned down a nursing position in Connecticut and accepted a position with the City and County of San Francisco as a Public Health Nurse in 1960. She would make San Francisco her home for the rest of her life.

It was during this time she met her future husband, James (Jim) Campbell, a third-generation San Franciscan. They married in December, 1961. The next chapter of her life began when she gave birth to her oldest son Timothy in 1962, Brian in 1964 (a short move south to Daly City in 1965), and Robert in 1967. Her boys were her pride and joy in life and became her sole focus after the untimely death of Jim in 1973. She raised the three boys by herself in Daly City attending as many baseball, basketball, and band concerts as humanly possible, eventually putting all of them through college. She retired from nursing in 1992, but she did not stay idle for long.

As a tribal citizen of Federated Indians of Graton Rancheria, she was elected to the Tribal Council in 1998 where she served multiple terms over 18 years, retiring in 2016 to spend more time with the second love of her life, Young Smith. While serving on the Tribal Council she was passionate about the tribe’s federal restoration, cultural revitalization projects including tribal language learning programs (Coast Miwok and Southern Pomo) and sharing traditional basketry skills.

She served on the initial boards of directors for the California Indian Basketweavers’ Association (CIBA) and the San Francisco Quilting Guild. She was an avid quilter as well as a Giants, 49ers, and Warriors fan throughout her entire life. She was also a great friend, aunt, mother, and grandmother. She never stopped being a nurse and continued to look after and help many families and friends right up until her passing.

She is survived by her three sons, Timothy (Bonnie), Brian (Carla), and Robert (Tina), her sister Leona Newman of Oak Harbor, Washington, as well as her 6 grandchildren (James, Ethan, Kayla, Miles, Emily, Chase), numerous cousins, nieces, nephews, and close friends. A funeral Mass was held at Church of the Good Shepherd in Pacifica, CA on July 7. Private burial will follow at a later date. A Celebration of Life gathering in Sonoma County will be held later this year.

Memorial donations may be made in her name to St. Vincent de Paul Society of San Mateo County at www.svdpsm.org, or 50 North B Street, San Mateo, CA 94401, 650-373-0622.

ANA Issues Racial Reckoning Statement: “We Ask Forgiveness From Nurses of Color…”

ANA Issues Racial Reckoning Statement: “We Ask Forgiveness From Nurses of Color…”

“To begin, we must acknowledge that from 1916 until 1964, ANA purposefully, systemically and systematically excluded Black nurses…”

The American Nurses Association (ANA) is taking a meaningful first step to acknowledge its own past actions that have negatively impacted nurses of color and perpetuated systemic racism. With the release of a formal racial reckoning statement on July 12, ANA is beginning a multi-phase journey of reconciliation, forgiveness, and healing. The Journey of Racial Reconciliation is the name for ANA’s racial reckoning journey as it seeks to address past racial harms from as far back as the formation of the association in 1896.

From the ANA statement:

“Similar to the concerns raised by Black nurses, in 1974, led by Dr. Ildaura Murillo- Rhode, a group of 12 Hispanic nurses who were also members of ANA came together to consider establishing a Hispanic Nurses Caucus within ANA because ‘ANA was not being responsive to the needs of Hispanic nurses.'”

“We know that ANA’s work to reckon with our historical and institutional racist actions and inactions is long overdue. Racism is an assault on the human spirit, and we want to be accountable for our part in perpetuating it. We have certainly failed many nurses of color and ethnic-minority nursing organizations, undoubtedly damaging our relationship with them and in so doing, diluting the richness of the nursing profession. We ask forgiveness from nurses of color as a first step to mend what is broken,” said ANA CEO Loressa Cole, DNP, MBA, RN, NEA-BC, FAAN.

“ANA recognizes that issues of racism persist today and continue to harm nurses of color. Findings from the Commission’s 2021 national survey on racism in nursing (n = 5,600) noted that racist acts are principally perpetrated by colleagues and those in positions of power. Over half of nurses surveyed (63%) said they had personally experienced an act of racism in the workplace with the transgressors being either a peer (66%) or a manager or supervisor (60%). Fifty-six percent of respondents also noted that racism in the workplace has negatively impacted their professional well-being.”

On June 11, 2022, the ANA Membership Assembly, ANA’s highest governing body, took historic action to begin a journey of racial reckoning by unanimously adopting the ANA Racial Reckoning Statement. Please read the entire statement and stay connected with ANA on its journey.

Study: Black Adults’ High Cardiovascular Disease Risk not Due to Race

Study: Black Adults’ High Cardiovascular Disease Risk not Due to Race

Findings from a new Northwestern Medicine study rebut the idea that Black individuals’ higher risk of cardiovascular disease is because of biological differences.

“The key take-home message is that racial differences in cardiovascular disease are not due to race itself, which is a social concept that is not related to biology.”

Black adults are at significantly higher risk (1.6-2.4 times) for cardiovascular disease than white adults. The new study found these large differences can be explained by differences in social determinants of health (like education or neighborhood-level poverty), clinical factors (like blood pressure) and lifestyle behaviors (like dietary quality).

“The key take-home message is that racial differences in cardiovascular disease are not due to race itself, which is a social concept that is not related to biology,” said corresponding author Dr. Nilay Shah, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “Rather, these differences in cardiovascular disease can be explained by differences in social and clinical factors. Clinicians should be evaluating the social determinants that may be influencing the health of their patients.

“The data from this study starts to identify what contributes to the higher burden of heart disease experienced by Black adults, and how much each factor matters.”

The study was published May 24 in Circulation, the flagship journal of the American Heart Association.

A breakdown of the findings

Black women had a 2.4-times higher risk for cardiovascular disease compared with white women. The study found that clinical factors, neighborhood-level factors and socioeconomic factors explained the largest components of the higher risk experienced by Black women.

Black men had a 1.6-times higher risk for cardiovascular disease compared with white men. The study found that clinical factors, socioeconomic factors and lifestyle behaviors explained the largest components of the higher risk experienced by Black men.

“The findings of significantly higher risk in non-Hispanic Black adults compared with non-Hispanic white adults is not surprising—this is well-known,” said senior author Dr. Sadiya Khan, assistant professor of cardiology and epidemiology at Feinberg and a Northwestern Medicine physician. “But it was surprising that the risk for cardiovascular disease was the same once social and clinical factors were considered over time. This finding is really important to rebut that there is an unexplained or genetic reason that Black individuals have higher risk.”

The study’s findings are important because they show that disparities in heart disease experienced by Black adults could be reduced by improving preventive care of heart disease risk factors and addressing social determinants, Shah said. The data provide a guide to identify strategies that may be particularly effective at reducing the persistent differences and disparities in heart disease that exist in the U.S.

“It is important to note that clinical risk factors, lifestyle and depression are not independent of socioeconomic status and neighborhood segregation,” Khan said. “Future research needs to go upstream to target social determinants of cardiovascular health. Our study lays groundwork to help inform community-engaged interventions that ensure equal opportunities for all people to have access to high-quality foods, environments and health care.”

The study evaluated data from about 5,100 Black and white adults who participated in the CARDIA (Coronary Artery Risk Development in Young Adults) Study at four locations in the U.S. (Chicago; Minneapolis, Minn.; Oakland, Calif.; and Birmingham, Ala.). The participants enrolled around 1985 and have been followed for over 30 years. The scientists evaluated the information participants provided starting from the time of their enrollment to determine the role of social and clinical factors in the differences in cardiovascular disease experienced by Black compared with white adults over the course of 30 years of follow-up.

Other Northwestern co-authors include Norrina Allen, Dr. Donald Lloyd-Jones, Mercedes Carnethon, Kiarri Kershaw, Lucia Petito and Hongyan Ning.

Funding for the study was provided by the National Heart, Lung, and Blood Institute (NHLBI) (grant K23HL157766); the National Institutes of Health (grants P30AG059988 and P30DK092939); and the American Heart Association (grant 19TPA34890060). The CARDIA study is conducted and supported by the NHLBI in collaboration with the University of Alabama at Birmingham (grants HHSN268201800005I and HHSN268201800007I), Northwestern University (grant HHSN268201800003I), University of Minnesota (grant HHSN268201800006I) and Kaiser Foundation Research Institute (grant HHSN268201800004I).

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