Clinical Appraisal: Recent Episodes
Ian A. Lane
What it takes to be a nurse scientist-in-training and a practicing clinician at the bedside requires a level of emotional maturity I think is likely entirely unique. I have immense respect for your work, and no one should ever make you feel as if you are a lesser researcher or scholar because of your clinical practice. Relationships with patients is why we do what we do.
Dr. Briere's recent publication can be read, here: https://www.mdpi.com/2072-6643/16/3/362
Don't become an evangelist for Capital S- Science. Instead, be open to the idea that you may not know what you think you know based on singular studies that have never been replicated, and may have results which actually fail the false discovery test.
How often should you expect the clinical research in your field to change your practice? If we assume Price's Law holds in health research regarding the validity of non-Null findings, we should expect a small fraction of published research to provide 'true' results. And amongst them, a smaller and smaller number will harbor all the 'large' effects.
Jackie Nikpour joins the podcast to discuss her crucial work in the space of primary healthcare and share her thoughts on what it means for RNs to work at the top of their license in primary healthcare in the U.S.
Dr. Pamela J. Grace joins the podcast for an episode dedicated to a discussion about how nurses can 'do right' by their patients.
Don't devalue new nurses' experiences and assume that, just because you've been in practice a long time it means your practice patterns are based on truisms. The way you've learned to do something and the fact that it's 'worked for you,' doesn't mean it's inherently true. Oftentimes, when studied, we learn what we thought we knew was true... isn't.
The burden of proof to demonstrate efficacy of biomedical tools (namely, drugs or surgery) is on biomedical scientists and physician-investigators. We are too quick, as a society, to assume their science is particularly good, just because it's popular, they're confident in what they do, and what they do appears impressive. Eminence is trumped by evidence every time, and some things that were hitherto dearly held beliefs by medical scientists as true have been crumbling down around them over the last fifteen years. Some biomedical findings are true and stand the test of time. Most don't.
It is easier to differentiate nursing from other health disciplines when you realize that the framework from which you're practicing not only implies unique processes but leads to distinct, if overlapping, outcomes, and that it's not all about tactics and techniques. Techniques and tactics, while similar, are grounded and applied from distinct frameworks of knowing and unique strategies, in service of often different goals.
I've recently made the case that I don't believe the NP is practicing nursing anymore, but that they're now medical providers. This is my attempt to buttress the opposing argument, rather that they are simply extending nursing thinking into a legislatively expansive domain of care provision.
Nursing is unique and we mustn't forget all the ways in which this is true.Medicine is almost always treated as 'the standard' against which other disciplines of healthcare are measured. But why should that be? What right has it earned to maintain that position beyond historical power hierarchies? Certainly contemporary evidence doesn't support that stance.You are an expert nurse. You are not a lower order version of medicine's implementation arm without prescriptive or diagnostic authority. And you're certainly not the punching bag for a medically-centered hospital system. You are an autonomous professional. Embody that and remember who you are and from where you came.
"Don't quantify your qualitative data." Except when you do it without realizing it...
Also, sidebar, yay for 100 episodes of the pod.
While qualitative research has challenges, quantitative methodology faces numerous challenges of its own. In the end, what can we really learn about human experience from either form of research? Only that which lies either on the margins, or that which can be captured in an overly simplified model.
In this episode, I speak with a well-respected PICU colleague of mine and bedside nursing expert, Michelle Boivin, BSN, RN, about how she has managed to maintain her bedside practice for over 20 years.
According to the fan-favorite 30-year celebratory piece she wrote in Nursing Science Quarterly in 2017, Dr. Jacqueline Fawcett, Ph.D., RN, FAAN implies that: because the 'medical model' doesn't exist as a conceptual model (from what Dr. Fawcett could find from a brief, non-systematic review), medicine, per se, does not have discipline-specific knowledge and, therefore, isn't a discipline but rather is a 'trade.' Ergo, "medical model" doesn't really exist at all.
This is all predicated on faulty reasoning, illogical leaps and poor empirical and philosophical work on the part of Dr. Fawcett. The fact that no one on the Editorial side of this publication didn't reject this just speaks to the fact that because Dr. Fawcett is a 'Living Legend," no one wishes to challenge her. This needed to be challenged, and is one of the sorts of pieces that does more harm to our profession publicly than it helps. This serves merely to alienate us from the rest of contemporary healthcare, at a time when our field continues to dwindle and our resources follow suit.
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An interesting RCT examining nasogastric tube securement devices versus standard taping methods on accidental dislodgment.
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What else is there to say.
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An excellent nurse-led RCT of an organizational-level nursing intervention for specialty wound care clinics. (Sili et al., 2023)
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A review of Lydia E. Hall's seminal 1963 work: "Nursing - What is it?"
An important addition to the Clinical Appraisal Nursing Theory podcast series and the inaugural YouTube video podcast upload.
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Struggling with imposter syndrome? In academics, this feeling never goes away. And there's no magical threshold that comes with taking more and more classes to makes you 'ready' to write that first grant or paper. It's time, now, to push yourself to new heights.
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A discussion with Nurse Theorist and Scientist, Dr. Bernie Garrett, from UBC School of Nursing, on the problem of New Age Spiritualism in Nursing.
A brief discussion of the challenges and biases that arise when interpreting qualitative research, as well as the pivotal role of clinical insights in advancing evidence-based practice in health sciences.
This episodes discusses the philosophical importance of skepticism in scientific pursuits.
In this episode, Ian speaks with his grandmother, Dianne Lane, a masters-prepared psychiatric nurse and nurse researcher who is now 90 years old. In it, she describes what life was like as a psychiatric nurse pre-psychotropic drugs.
What is an advanced nurse? Is prescription authority synonymous with APRN practice? What constitutes an APN? These are issues dealt with in this episode of the podcast.
In this episode, Ian speaks with National Association of Clinical Nurse Specialists (NACNS) President, Dr. Phyllis Whitehead, PhD, APRN/CNS, FAAN, about how she conceptualizes the unique contributions to patient care of CNS trained nurses and how one might differentiate the roles of CNS practitioners from nurse practitioners.
In this conversation, Ian talks with Dr. Stephanie Griggs, PhD, RN, FAAN, a sleep self-management expert in pediatrics, focused on young adult health. Stephanie is an assistant professor of nursing at Case Western Reserve University and an up-and-coming force to be reckoned with in academic sleep and diabetes self-management research. Specifically, Ian and Stephanie talk about her academic trajectory and how she came to be using a novel time series modeling technique known as cosinor models to better understand the nuances of individuals' patterns and biological rhythms.
In this episode, Ian discusses the importance of understanding research design and analysis to accurately determine the efficacy of research findings, as well as the frequency with which most research findings are demonstrably proven 'false' over time, according to researchers at Stanford. Additionally, he discusses the impact of clinical scholars understanding how to piece together methodological designs while reading wide swaths of clinical literature and how it makes their critical appraisal skills better.
In this episode, Ian details his journey through quantitative health science and how he originally became interested in statistical methods as applied to research on human health.
Reality testing is needed to assess the validity of your abstract constructs, and if it cannot be shown to hold outside of your mental ideals... I am sorry, but it's wrong. We need to go back to the drawing board, in some sense.
In this episode, Ian concludes his arguments from the last year as to why we need a track for the DNP-prepared clinical researcher, separable from PhD-typical training pathways, for nurse scientists at the applied or practice-based setting, by teasing apart many of the usual rebukes of this idea that come from traditionally prepared scientists and skeptics. Rebutting many of these positions, Ian points out many logical flaws and inconsistencies in the argument that we ought not prepare a small cadre of DNP clinical experts in translational and clinical research, in an effort to help people understand that there is value in this position, and that other fields are already pursuing it, successfully.
In this episode, Ian discusses the science of labor and delivery with Melissa Anne Dubois, a seasoned L&D nurse and soon-to-be Nursing PhD student. They passionately discuss all things maternal health, in the context of what we can learn from the trials that currently exist and where they tend to fall apart from a nursing perspective and potentially fail millions of women and infants. A dynamic guest, Melissa Anne does a great job of being charitable to the medicalization of the birth process where it's warranted but is perfectly willing to shed light on the areas that are in desperate need of improvement for the sake of women's health.
In this episode, Ian speaks with Dr. Anne Marie Rafferty, a nurse, scholar, educator and historian from the UK, about a 1996 book she published entitled "The Politics of Nursing Knowledge," which was largely predicated on her doctoral dissertation work in medical sociology and modern history. They discuss how the book has shaped her career, her thinking, and where some of the big problems are in need of tackling in the field, and traverse elements of the historical context that undergirds many of these contemporary nursing and health policy issues.
In this episode, Ian interviews a Living Legend in Nursing, Dr. Jacqueline Fawcett, PhD, RN, FAAN. Jacqueline is internationally recognized for her work in meta-theoretical underpinnings of nursing science and practice, and has been credited as revivifying a term from the 1970s, "Nursology", as being most appropriate for our discipline, to distinguish it as a discipline similar to biology or psychology or sociology. Ian was able to ask Jacqueline why she prefers the term and where it originated, how she envisions the linkages between theory and practice in nursing, and how and whether it is possible or necessary to develop a theory-driven nursing science. Enjoy!
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In this episode, Ian responds to a listener question about how he reconciles the apparent contradiction in his recent claims about how most nurses eschew nursing theory so we need to make it more pragmatically relevant to practicing nurses, with the idea that he still finds Nursing Theory to be relevant and important and worth embracing and taking seriously.
In this episode, Ian discusses the importance of clinical trade offs and the implications of the multiplicity problem in terms of real world effects of our overly simplistic theories.
In this episode, Ian details his methodology for reviewing intervention studies, particularly randomized controlled clinical trials (RCT) and other human subjects experiments in the biomedical or biobehavioral sciences. This is merely the method that has worked for him over the years, and provides the most bang for his buck. Others' mileage may vary of course. But these are the pieces at least to be on the lookout for, when reading intervention research in biomedicine.
In this episode, Ian speaks with Dr. Rosemary Taylor, PhD, RN, CNL, an experienced nurse and academic scholar with a wealth of knowledge and an interest in studying interpersonal violence, bullying and other noxious behaviors in the health care environment, particularly amongst nurses. Nurse on nurse "horizontal violence" as she has termed in in her dissertation defense and beyond is a construct which has been notoriously difficult to measure and evaluate in the research on this topic, and Dr. Taylor's life's work is to help tease apart these issues in an effort to disentangle the structural barriers to intervening and improving the work environment for individual nurses. In particular, Ian and Rosemary talk about her three 'subtypes' of nursing bully, as elucidated by her PhD thesis.
In this episode, Ian revisits the notion of number needed to treat (NNT) and absolute risk ratio (ARR) from a few episodes ago, in light of some new claims made about mAb therapies for the treatment of COVID-19 patients, given some of the public support for their early use. As always, the approach taken is a methodological one, and the focus is not on COVID-19 per se.
In this episode, Ian speaks with Dr. Patricia M. Delgado, DNP, APRN, DCNP. Patricia is a DNP-prepared principal investigator with extensive training in adult-gerontological primary care and subspecialty training in dermatology about her journey into clinical research, what hurdles she overcame to be afforded the opportunity to be a PI, and her perspective on the viability of this path for others with similar training. Her interests in the intersection of psychiatric and dermatological research was also discussed, from the perspective of there being unique and important questions to answer from her vantage point as a DNP-prepared clinical researcher.
In this episode, Ian reviews some literature and some questions surrounding the idea of whether quality improvement (QI) projects are just "research lite" or whether they have valid standing in and of themselves apart from research. Many people have written on whether QI is just 'research which doesn't require IRB approval and can't be gneralized,' while others are staunch proponents of the immediacy and primacy of QI initiatives, for various reasons, some of which will be explored in this episode. Ian discusses three primary components of this problem which are interesting to him: 1. QI and research may only differ on the front end regarding human subjects and ethics committees, 2. QI and traditional clinical investigations might be bridged by leveraging implementation science, and 3. generalizability and statistical inference may be the Achille's heel of the QI proponent.
In this episode, Ian discusses some methodological challenges in properly interpreting emerging data from the COVID-19 pandemic, specifically surrounding the Delta variant of concern (VOC).
In this episode, Ian takes a more esoteric thought-ride through the bramble of lived experience and shared health-illness experiences to arrive at a tentative conclusion that perhaps the development of a methodology to evaluate the ontological legitimacy of an externally valid measure of shared health-illness experiences is perhaps tenable after all... (then again, this is all just interesting pontificating at this point).
In this episode, Ian speaks with physical therapist and hip pain researcher extraordinaire, Dr. Marcie Harris-Hayes, PT, DPT, MSCI. Dr. Harris-Hayes is on the faculty at Washington University School of Medicine in St. Louis, where she advises trainees interested in clinical research and conducts her own independent program of research focused on arthritic and pre-arthritic hip conditions. She has been an independently funded scientist translating the work of her colleagues from the bench to the bedside for a number of years, and joins the podcast today to speak with Ian about what the path looks like for an MSCI-prepared clinical investigator with a practice-doctorate, as opposed to the more traditional PhD pathway for those who learned later on that they were interested in a career in clinical research.
In this episode, Ian speaks with Dr. Yvette P. Conley, Ph.D., FAAN of University of Pittsburgh School of Nursing about her experience as a human molecular geneticist working in Nursing Science, to untangle the complexities of symptom development and about nursing research using omics techniques more broadly.
In this episode, Ian speaks with Dr. Angela Starkweather, PHD, ACNP-BC, CNRN, FAAN, Professor of Nursing at UConn School of Nursing and NINR-funded translational pain scientist, about biobehavioral mechanisms of pain and symptom self-management. They also talk at length about maintaining clinical competence as a clinical researcher in nursing science and balancing one's career aspirations across domains.
In this episode, Ian speaks with Dr. Theresa A. Koleck, PhD, RN, from University of Pittsburg School of Nursing about her expertise in omics and biomedical informatics. Dr. Koleck recently published a fascinating first-author paper in Nursing Research focused on the use of natural language processing (NLP) in the study of five deliberately selected symptoms. This project was a methodologically-focused feasibility pilot of the use of NLP and the NimbleMiner R-Studio Shiny package, created by one of her nurse scientist colleagues at Columbia University (Dr. Max Topaz). Additionally, they discuss Dr. Koleck's broader interests in symptoms and symptom burden.
In this episode, Ian speaks with NIH Lasker Clinical Scholar, Dr. Paule V. Joseph, PhD, CRNP, FAAN, about her experiences as a nurse scientist focused on the translation of basic science questions into practice. Her work specifically concentrates on chemosensory (taste and smell) dysfunction arising from metabolic conditions(i.e., obesity) , but she has a wealth of experience in every facet of clinical investigation, and simultaneously continues to practice as an advanced practice nurse, board certified in family practice. As she has become an impromptu mentor for Ian, he was extremely grateful to have the opportunity to interview her on the podcast. Please enjoy this invaluable episode.
In this episode, Ian reviews a 2016 paper in Diabetologia predicated on the self-care management of type 2 diabetes with a walking intervention aiming to evaluate 10-min. post-meal walks 3x/day compared to standard 30-min. walking advice for daily physical activity in an effort to control blood sugar levels.
In this episode, Ian had the pleasure of speaking with Dr. Martha A. Dawson, DNP, RN, FACHE, an esteemed nurse executive, Associate Professor of nursing at the University of Alabama at Birmingham. Dr. Dawson is a health administration expert and implementation researcher, and the current President/CEO of the National Black Nurses Association (NBNA). This inspirational interview describes Martha's dynamic journey through nursing and health administration into positions of leadership within the profession and concludes with poignant advice to budding nurses about their future careers as well as a gripping discussion on the need to improve diversity in the healthcare workforce.
In this episode, Ian speaks with Dr. Joshua Lea, DNP, MBA, CRNA, an Assistant Clinical Professor at Northeastern University's School of Nursing, about his research interests in occupational wellness and burnout amongst healthcare professionals and nurses in particular, including the importance and ramifications of this issue for both providers and for patients.
In this episode, Ian speaks with Dr. Maureen Moriarty, DNP, ANP, FAHS, a primary care headache specialist with a private practice in Maryland about her journey through academics and to becoming a principal investigator.
In this episode, Ian has a discussion with Dr. Susan Strobel, DNP, MPH, RN, Assistant Professor of Nursing and Public Health at University of South Dakota, about her experiences as a DNP-prepared clinical investigator and academic scholar. This is part one in a brief series called "Showcasing DNP Scholars." (If you know exceptional DNP-prepared nurse scientists or academicians, please send Ian an email at clinicalappraisal@gmail.com nominating them for an interview! And if you are that DNP-prepared nurse, and you're interested to come on and talk about your journey, please send along that email!)
In this episode, Ian describes some of the better and worse reasons to pursue a PhD in Nursing Science, from his perspective having spent time in a PhD program and working under PhD-prepared investigators at the medical school prior to entering graduate studies. This is a response to a listener question.
In this episode, Ian discusses the question of whether PI eligibility status is granted on the basis of having earned a PhD and what role a DNP-prepared investigator might serve in clinical research as a team lead. Furthermore, Ian describes the many avenues a DNP-trained professional nurse interested in pursuing an academic research career might go about trying to make this dream a reality.
In this episode, Ian describes what Community-Based Participatory Research (CBPR) is and what Participatory Action Research methods often look like when done comprehensively, and details just a few of the myriad ways it could be beneficial for nurse researchers to adopt as a methodology in their patient-oriented outcomes related scientific work.
In this episode, Ian speaks with Dr. D. Anthony Tolentino, PhD, RN-BC, a National Clinician Scholars Fellow at the University of Michigan School of Nursing about his experience working in health informatics as a nurse informaticist and gaining some insight not only into the types of methods and analyses Dr. Tolentino has used in his work (including computational ethnographic methods using Markov chain models and more) but also how he's become gripped by the problem of disaggregating health data for minoritized groups to improve self-management of disease. His particular population health focus is on type II diabetes outcomes in Filipino-Americans. Enjoy!
In this episode, Ian discusses relative versus absolute risk ratios and number needed to treat (NNT). In it, he describes some of the ways each are used and under what conditions it might be best to use one over the other, as well as what precisely the NNT really means. Finally, he concludes with some thoughts about how interpreting regression output is bound to be a vital skill for DNP-prepared nurses to adequately translate the science of nursing into their practices.
In this episode, Ian describes an issue he sees with qualitative analysis, whereby a kappa coefficient for inter-rater reliability is often met and then forgotten about, once, but that consistency in these reliability scores is problematic both within raters but also between raters. Furthermore, there is an issue of inter-subject disagreement and intra-subject disagreement. In the end, there seems to be a test-retest reliability problem both within and between subjects in qualitative analysis, which has heretofore not gotten much attention in the methodological realm, which Ian is attempting to shed some light on in this opinion piece.
In this episode, Ian riffs off-the-cuff about a fascinating book he's currently reading by Dr. Janice Morse, a well-regarded anthropologist and nurse researcher who pioneered the field of qualitative health research, laying out some of the advantages and disadvantages, as well as some of the limitations, of qualitative methodology and how it ties into the philosophy of science conversations which have occurred recently on the podcast.
In this episode, Ian details a nice paper by McLaughlin, Hartjes, and Freeman who tracked 20 of their own Neuro ICU patients who were receiving the standard hour-by-hour neurological examinations after admission to the Neuro ICU to find out whether sleep deprivation might be related to the potential for seeing increased neurological deterioration or ICU delirium during their tenure on the unit. The proposal is that this effect, if observed, might be mediated or moderated by sleep deprivation. This was a single-arm, prospective, natural history cohort design, designed to look at their pt population prevelance of neurological decline or delirium, and as such is purely descriptive in nature. But these authors did a commendable job in detailing the descriptives and frequencies of their sample, and raise fascinating and important questions which are sure to lay the groundwork for an important experimental literature to follow.
The title says it all. (Note: The concept of "Nursing Praxis" has been referred to as a kind of seamless union of Nursing Theory, Practice and Research.)
In this episode, Ian passionately describes his reasoning behind the belief that Nursing Theory ought to backpeddle toward practitioners as the existential philosophical enterprise has it seemingly running toward extinction, as it leaps further and further away from what practitioners actually need or care about. Then he reads through 21 definitions of what Nursing is or consists of by the thought leaders of our field from Nightingale onward, save only a few, and discusses some of his agreements and contentions with these thinkers perspectives. Ultimately, as Dr. Rosemarie Rizzo Parse has written, previously, philosophical debate is at the heart of nursing, and it's time we infuse this conversation with some pushback that isn't the naivety of an undergraduate simply not wanting to complete their Nursing Theory paper, because it seems silly to them.
In this episode, Ian decribes two different definitions of what constitutes nursing - one from the 1960s and one from the 1990s, as nursing science trended toward an epistemology much more tightly aligned with postmodern existentialism as it moved away from logical empiricism. This is to provide a glimpse of what may frustrate students about Nursing Theory coursework; it often strikes them as not useful or relevant or even related to their clinical practices, which is why they generally sought nursing as a career in the first place. This isn't to say Nursing Theories and their respective definitions of nursing practice aren't highly valuable, it's just to say that they're not all of equal validity, and undergraduate students simply do not have the time or bandwidth or inclination to sort through them. (Hopefully, they can join us on the podcast to tease these out over time and come to their own conclusions.)
In this episode, Ian continues a conversation on the necessary constituents of what comprise Nursing Science as such. A continuation of the previous episode, this time Ian gives such compelling reasons why we ought not consider nurse scientists to merely be researchers who identify as nurses. In the end, the position Ian lands on is that it may indeed be the case that Nursing Science exists, per se, but that it must be founded on theoretical conceptualizations and conceptual models unique to the discipline of nursing, which necessitates a clear definition of Nursing itself.
In this episode, Ian describes some plausible distinctions between nursing and medicine and, thus, nursing science and medical science. Beginning with fundamental definitions and philosophical considerations, he contends that there may in fact be a distinct nursing science paradigm set apart from other disciplines in the sciences, but in order to conclude that we must first generate a consensus definition on what sets apart nursing from medicine in the first place. The construct of a 'nursing science' hinges entirely on the operational definition of what is Nursing, per se. In the end, this is an exceptionally complicated question Ian does not have an answer to, but is working to tease out a panoply of possibly viable interpretations. Enjoy.
In this episode, Ian speaks with David Warren, NP, a triple-board certified nurse practitioner about his practical experiences as a clinical expert in the field of emergency care across six years of travel nursing. Together, they discuss some of the challenges David has seen in the contemporary field of advanced practice nursing, specific to nurse practitioners, and speculate about ways high-quality nursing research may be leveraged to address some of these concerns. Furthermore, Ian takes the opportunity to ask David, who has worked alongside numerous healthcare providers across several state lines, what he sees as some pivotal areas nurse scientists should infuse themselves into opportunitistically in order to further improve the healthcare landscape.
In this episode, Ian speaks with Dr. Anne Sales, PhD, RN, a nurse and professor in Michigan and a notable health services researcher. A founding co-editor in chief of the journal Implementation Science Communications, Anne discusses with Ian the advent of implementation science as a discipline and its relationship to health services research and nursing science.
In this episode, Ian speaks with Catherine Nagawa, MS, a PhD student in her final year of a clinical & population health research program, whose work focuses on health behavior change and smoking cessation. She joins Ian today to discuss how the various theories of health behavior might be applicable to things nurses and nurse researchers care about, including clinical interviewing, self-management of disease, health promotion and disease prevention. Enjoy!
In this episode, Ian goes through a recent, interesting paper published in the Journal of Intensive and Critical Care Nursing by Vreman and colleagues from the Netherlands, wherein the authors describe the sound pressure effects of various alarm bells in differing ICU environments, at various timepoints throughout the day.
In this episode, Ian discusses the internalization of nursing theories in the everyday practice of nursing which is taken for granted as just being part and parcel of nursing, but which actually resulted from the theorizing of specific nursing thinkers throughout the ages. In an attempt to help bridge the gap between practice and theory, Ian sees one of the many necessary steps as helping nurses on the ground who reject theory outright to see where they've actually introjected these theories into their practices, despite their purported rejection of the ideas from an academic perspective.
In this episode, Ian speaks at length with John Canion, NP, a board certified emergency nurse practitioner in the State of Texas, who has become passionate about NP educational reform. John walks Ian through his thinking on where the current problems are, from where they may have arisen, and what he sees as some viable movements forward to overcome some of the political strife the field is contending with. Please feel free to share comments or questions; John has graciously offered to come back on again, anytime. Enjoy!
In this episode, Ian ponders the mostly absent male perspective in nursing theory and research and speculates a little about why that is and what might be its relevance to the continued improvement of the still young discipline.
In this episode, Ian maps out the origins of the Clinical Appraisal podcast, how things have gone, and where he sees them moving from here as the show evolves over time, based on his current interests in theory and methodology.
In this episode, Ian interviews Nili Steiner, MSN, RN, SCRN working in a major stroke center at a level 1 trauma center in Los Angeles county, California, who has been an emergency nurse for 28 years and a stroke nurse for 11 years. Recently, pre-COVID-19, she led a pre-hospital PCA stroke education program for parademics and pre-hospital providers and joins Ian to discuss her community Implementation Project. Enjoy!
In this episode, Ian talks with statistics professor, Dr. Joshua W. Lambert, Ph.D., from the University of Cincinnati College of Nursing, where Dr. Lambert helps foster the development of statistical competencies in graduate nursing students in both the PhD and DNP programs. He joins Ian in discussion about an editorial he wrote for the Journal of Nursing Education (JNE) in January, 2020, wherein he describes some useful statistical tests for DNP students.
In this episode, Ian had the great pleasure of interviewing Dr. Patrick Lyden, MD, of University of Southern California Keck School of Medicine in the division of Neurology, where he asks Dr. Lyden some fundamental questions about the NIHSS instrument. Enjoy!
In this episode, Ian provides some musings on the problem of research and COVID-19 and what things might look like had we had larger swaths of nurse researchers able to participate in the larger conversation of public health throughout the pandemic.
In this episode, Ian details a recently published study in JICCN discussing the willingness of ICU nurses at the bedside to provide care to COVID-19 patients in the first wave of the pandemic, in Syndney, Australia. This was a prospective cross-sectional, single-center observational study designed to evaluate potential predictors of nurses' willingness, and concluded that communication from management was an important consideration. More importantly, however, Ian describes how this question of how to stop the loss of bedside nurses due to burnout and fear of illness from the pandemic and maintain the integrity of the workforce is crucial to the current discussion, since nurses, in many ways, are health care.
In this episode, Ian addresses a quesionner's concerns over his spending 01:21:00 on the podcast bolstering the perspective of his debate opponents' views on one argument related to restricting DNP-prepared scholars in the conduct of academic nursinng research. It is about respect and understanding others' perspectives, to enhance our own and to improve and increase cross-communication. Enjoy.
In this episode, Ian steel man's one compelling argument against the DNP-prepared clinical investigator. Namely, the fact that DNPs are intended to be prepared as broad-based clinical and practice-change experts, which does not afford for the siloing which must occur for PhD-prepared scholars to be effectives scientist-researchers in their content areas of expertise. This was recorded for the sake of those listeners who may have felt over the last few episodes that Ian may not fully understand some of the more nuanced and important reasons to suppress this notion - albeit just one of the different arguments against it. He concludes by talking about why he feels these should not take away from the DNP-prepared scholars opportunities to participate in the research conversation, independently. Thanks for listening.
As a response to a listener's question, Ian addresses in this episode the core differences, as he sees them, between what is efficacy research and what is effectiveness research and tries to gives a few examples of them both. A fairly large topic in and of itself, Ian felt this was worthy of its own podcast episode. Look out for the next episode, which will be released shortly and will feature the next full-length research review. Happy New Year!
In this final episode in a saga on the hypothetical demarcation problem in academic nursing research between DNP- and PhD-trained clinical investigators, Ian describes the importance of individual professionals' values and self-identification with practitioner-scholar or research scientist and how there are larger considerations at play, here, than merely the programmatic-level factors of one's doctoral study. Ian discusses the shortage of tenured research faculty in clinical nursing research in the United States and how a new cadre of properly trained DNP-prepared research scholars designed to augment and facilitate dissemination of the work of their nurse PhD colleagues should be fostered rather than suppressed, and discusses some new relevant data indicating that a large proportion of nursing-specific funds doesn't even go to nurse scientists. Email comments and questions to: clinicalappraisal@gmail.com.
In this third AMA episode, Ian answers the following three questions: 1.) Isn't the DNP a "clinical doctorate?;" 2.) Ought we just do away with DNPs focusing on research altogether in favor of becoming direct-entry clinical doctors?; and 3.) What is the difference between "basic research methodology" and "outcomes evaluation methodology" re: PhD v. DNP, respectively?
In this episode, Ian continues his discussion of the DNP as compared with the PhD in terms, specifically, related to the conduct of original academic and clinical research. The paper reviewed, today, was published in the Journal of Professional Nursing in 2020, by Dr. Krystal Canady, DNP, and is entitled: "Practical and philosophical considerations in choosing the DNP or PhD in nursing."
In this episode, Ian responds to a few polite criticisms of his previous episode on DNP versus PhD-level research, and then describes a useful and important 2020 editorial review in Nurse Leader, describing challenges faced by newly graduated DNP-prepared nurses in acute care workforce settings.
In this episode, Ian thinks through the question of how to differentiate the role of the DNP as compared with the PhD in Nursing, from an academic research perspective. Although these are just thoughts and contemplation, there is something here for both DNPs and PhDs in nursing science and the hope is that it merely spurs something of an interesting dialogue about the overly simplistic heuristics about DNPs as translators and PhDs as originators of 'knowledge' in the field.
In this episode, Ian reviews a seminar New England Journal paper by Herridge et al. (2011) discussing functional disability longitudinally post-ARDS treatment across four MICU and SICUs in Canada. The paper details the functional, psychosocial, and medical impairments that have appeared to linger in this sample across five years of follow-up data collection. This paper is considered one of the top 100 critical care studies ever published.
In this episode, Ian reviews a 2016 paper in Stroke by Condon et al. describing a prospective RN/NP-led transitional stroke care program including follow-up calls and clinic visits after patients were discharged to home from a single-center hospital system. This program intended to review two phases of the TSC program to assess any potentially significant improvements across the phases of implementation from phase 1 to phase 2 in terms of reducing 30- or 90-day readmission rates.
In this episode, Ian interviews APRN Briana Juskowiak, a certified nurse practitioner in Georgia, who has spent the length of the COVID-19 pandemic working as an ICU NP, treating COVID-19 patients on the front line. Bree joins Ian in this episode of Clinical Appraisal to discuss her experiences in a COVID hot spot and to discuss an article from Shah et al. (2020) published in Critical Care Medicine discussing the possible futility of resuscitation efforts of in-hospital cardiac arrest. Bree can be found on YouTube by searching: "Bree Juskowiak"! Enjoy!
In this Ask-Me-Anything episode, Ian answers three listener questions. Question one asks about Odds Ratios. Question two asks whether nursing and medicine are more Art or more Science. And question three asks what the main difference is between what broadly constitutes medicine and what constitutes nursing. Enjoy!
In this episode, Ian reviews a recent Nursing Outlook paper on Workforce Outcomes in nurse practitioners as a result of changes in full practice authority legislation during the period of 2010-2018. This study was designed to assess whether instituting full practice authority legislation in states that previously did not have it might improve workforce outcomes in NPs which might thereafter have important downstream effects on health professional shortage areas (HPSA) and other important health services indicators.
In this episode, Ian describes how implementation is the key missing link in what might bring together academic-based nursing research and clinical nursing practice, and discusses how the DNP model of terminal training in nursing practice may be the proper conduit for this level of translational and implementation science and policy development.
In this colloquial episode, Ian first answers two listener questions and then dives into how he thinks about doing a "quick read" through scientific articles, and paraphrases a new paper he's not yet read before live for the audience. The point of this is different from his usual deep dives into the literature; it's to give his audience a sense of what sorts of questions they might ask themselves and what pieces to look out for as they walk through an article, from the standpoint of a clinician trying to stay up to date, but still doing a critical appraisal of the research.
In this episode, Ian gives an argument for why integrating others' values into our interpretations of data (whether in dialogue with another person through conversation or with respect to our scientific inquiry in health care research) is an imperative way to model reality more accurately, and discusses the fact-value overlap in statistical inquiry in scientific research.
In this first AMA episode of the Clinical Appraisal podcast, Ian provides his thoughts on two listener questions which were recently emailed, both about the COVID-19 pandemic and some of the more recent metrics which were used to evaluate data on patient outcomes. The first related to excess all-cause mortality, and the second to masking-related decreases in hospitalization rates.
In this episode, Ian discusses the issues the nursing profession may face if its students continue to eschew things like Nursing Theory or professional advocacy, and generally philosophizes and pontificates about the larger problems which might result from continued demonization of our forebears.
In this episode, Ian picks apart a famous study on substituting NPs for GPs in the Dutch health system, in 15 primary care practices across The Netherlands. It's just one of a large swathe of research that now exists comparing NPs to physicians, but this one is fairly prestigious and Ian describes the things about it which are good, but also that which left much to be desired. This is the first of many on this topic. Ian will be reviewing every randomized trial comparing NPs to "standard" medical reference groups which has ever been published, and he'll present them all on this podcast for you to learn about and make up your own mind on. Enjoy!
In this episode, Ian presents an idea as Nursing Theory mediating between clinical research and clinical practice in the discipline of nursing, and discusses some philosophical reasons why so many individuals may undervalue the theoretical approaches to clinical nursing, and how, on the whole, this may be naive.
In this episode, Ian reviews a new 2020 paper on interventional versus conservative management for primary spontaneous pneumothorax in adult patients.
In this episode, Ian reviews a Turkish study on ICU patients which sought to learn whether ROM exercises could prevent or reduce incidence of delirium in a subgroup of NIMV ICU patients over 65 years of age, or decrease the duration of delirium in this same sample of patients, should they develop it during their stint on the unit.
In this episode, Ian discusses an article from the Journal of Neuroscience Nursing, published back in 2018, on a prospective case review of 100 patients, where the NPs were evaluated on their ability to properly triage surgical cases to the consulting surgeons.
In this brief episode, Ian discusses the latest CDC reports of a "mere 6% of COVID-19 deaths due to SARS-CoV-2 infection alone" and describes how that misinterpretation is harmful and inappropriate.
In this episode, Ian presents another mathematical thought experiment, but framed again around developing optimism and, potentially, fighting against depressive tendencies to consider oneself a meaningless island amidst the chaotic landscape of the social relationships around them. Considering social cognition from the network standpoint, Ian encourages his listeners to consider themselves more like nodes in a network of neurons than as islands or drops in a bucket, which has little to no impact.
In this episode, Ian details the differences between qualitative research and quantitative research in nursing and other health sciences and discusses the value of qualitative work in particular, which is often eschewed by quantitatively-oriented researchers.
In this episode, Ian discusses a recently published research study in the Journal of Neuroscience Nursing, purporting to show that music therapy in the inpatient setting can aid patients with disorders of consciousness, intricately detailing the strengths and weaknesses as he understands them. He believes this to be an important contribution to the field of neuroscience nursing and hopes others will follow the authors' sentiment that more work ought to be conducted on this question.
In this more philosophical episode, Ian uses combinatoric probability to describe the often infinite combinations of discrete items possible across various contexts and how, knowing this, may enhance compassion through the acknowledgement of one's own limited conclusions.
In this episode, Ian uses a thought experiment coupled with some limited data on BPD to explore the question of whether someone with a Cluster B "personality disorder" is capable of lasting, meaningful behavior change. Implications of this not being the case are explored, superficially.