THE discussion of nursing continuing education in the United States is approached by a consideration of the following aspects: Definition and Background Evolution of the Concept Administration of the Process Teaching Techniques Range of Subjects Evaluation of the Program Issues and Problems: Mandatory vs. Voluntary Participation Control of the Accreditation Process Responsibility for Participation Program Cost/Availability
Full Text Available THE discussion of nursing continuing education in the United States is approached by a consideration of the following aspects: Definition and Background Evolution of the Concept Administration of the Process Teaching Techniques Range of Subjects Evaluation of the Program Issues and Problems: Mandatory vs. Voluntary Participation Control of the Accreditation Process Responsibility for Participation Program Cost/Availability
Scott, Elaine S
Providing nursing administrators with excellent educational programming is imperative for the profession. The author analyzes trends in nursing administration education in the United States and how they compare with standards and future recommendations for graduate curricula. The degrees conferred, curricula, hours of study, and educational modalities are examined in 57 master's degrees in nursing programs with concentrations in administration.
da Gloria Miotto Wright, M; Godue, C; Manfredi, M; Korniewicz, D M
To identify international health activities in United States, Latin American, and Caribbean schools of nursing. In the international community, nurses face challenges similar to those in related professions, but without the benefit of a long tradition. There is little research about how nursing education and associated activities prepare nurses to deal with international health, and little information about the extent of international health activities in U.S. schools of nursing. Descriptive. Using a questionnaire with 16 items, a survey was conducted in 1995 on a random sample of representatives from 100 university schools of nursing in the United States plus 15 schools with known international activities (10 from the United States and 5 from Latin America and the Caribbean). International health as a program topic was found in one-third of U.S. schools of nursing. However, nursing curriculums do not integrate international health with other subjects. Also, partnerships with foreign institutions are incipient and international health activities are usually individual initiatives with little institutional support. For nurses to become major contributors to international health, nursing curriculum content must shift from "international nursing" to "international health." Programs of nursing education should include study of social, economic, and political factors that affect health care systems. Schools should develop partnership agreements.
Rogowski, Jeannette A.; Staiger, Douglas O.; Patrick, Thelma E; Jeffrey D Horbar; Kenny, Michael J.; Lake, Eileen T.
The neonatal intensive care unit (NICU) is a setting with high nurse-to-patient ratios. Little is known about the factors that determine nurse workload and assignment. The goals of this study were to (1) develop a measure of NICU infant acuity; (2) describe the acuity distribution of NICU infants; (3) describe the nurse/infant ratio at each acuity level, and examine the factors other than acuity, including nurse qualifications and the availability of physicians and other providers, that deter...
Registered nurses have been attempting to achieve professional status for nearly a century. Historical investigation of their efforts in the United States and a case study of the 1976 Seattle Nurses' strike indicate major obstacles to the professionalizing project. The most important of these are the inability of the nurses to control the labor supply, and their failure to define or monopolize a distinct set of tasks. One result is functional redundancy: there is no job nurses perform that is not also performed by some other occupation.
Rogowski, Jeannette A; Staiger, Douglas O; Patrick, Thelma E; Horbar, Jeffrey D; Kenny, Michael J; Lake, Eileen T
The neonatal intensive care unit (NICU) is a setting with high nurse-to-patient ratios. Little is known about the factors that determine nurse workload and assignment. The goals of this study were to (1) develop a measure of NICU infant acuity; (2) describe the acuity distribution of NICU infants; (3) describe the nurse/infant ratio at each acuity level, and examine the factors other than acuity, including nurse qualifications and the availability of physicians and other providers, that determined staffing ratios; and (4) explore whether nurse qualifications were related to the acuity of assigned infants. In a two-stage cohort study, data were collected in 104 NICUs in 2008 by nurse survey (6,038 nurses and 15,191 infants assigned to them) and administrators reported on unit-level staffing of non-nurse providers; in a subset of 70 NICUs in 2009-2010, census data were collected on four selected shifts (3,871 nurses and 9,276 infants assigned to them). Most NICU infants (62%) were low-acuity (Levels 1 and 2); 12% of infants were high-acuity (Levels 4 and 5). The nurse-to-infant ratio ranged from 0.33 for the lowest-acuity infants to 0.95 for the highest-acuity infants. The staffing ratio was significantly related to the acuity of assigned infants but not to nurse education, experience, certification, or availability of other providers. There was a significant but small difference in the percentage of high-acuity (Levels 4 and 5) infants assigned to nurses with specialty certification (15% vs. 12% for nurses without certification). These staffing patterns may not optimize patient outcomes in this highly intensive pediatric care setting. © 2015 Wiley Periodicals, Inc.
Krantzler, N J
This paper analyzes images of physicians and nurses presented in advertisements in the medical and nursing journals JAMA (Journal of the American Medical Association) and AJN (American Journal of Nursing). Advertisements are viewed as hyper-ritualized displays of symbols and rituals associated with medical and nursing practice, both reflecting and reaffirming stereotypes and beliefs that are widely held in the society at large. Trends over the past few decades show that medical advertisements are dropping some traditional symbols (such as the white coat and stethoscope) in favor of depicting science-in-action and high technology. Nursing advertisements, however, are more frequently utilizing the symbols formerly reserved for physicians. Both physicians and nurses are depicted in their respective journals as existing largely independent of one another. While these advertisements clearly do not depict social reality, they present a fictionalized version which reflects and reproduces some of the expressed ideals in medical and nursing practice.
Cong, Xiaomei; McGrath, Jacqueline M; Delaney, Colleen; Chen, Hua; Liang, Shuang; Vazquez, Victoria; Keating, Laura; Chang, Kimberly; Dejong, Angela
Despite growing knowledge, neonatal pain remains unrecognized, undertreated, and generally challenging. A cross-sectional survey study was conducted to investigate neonatal nurses' perceptions, knowledge, and practice of infant pain in the United States and China, including 343 neonatal nurses (American nurses [n = 237]; Chinese nurses [n = 106]). Nurses' responses regarding neonatal pain reflected adequate knowledge in general pain concepts, but knowledge deficits related to several topics were found (e.g., preterm infants are more sensitive to pain and long-term consequences of pain). Most reported regular use of pain assessment tools, but fewer agreed that the tool used was appropriate and accurate. More American nurses (83%) than Chinese nurses (58%) felt confident in the use of pain medications, while more Chinese nurses (78%) than American nurses (61%) acknowledged the effectiveness of nonpharmacologic interventions. About half reported that pain in their units was well managed (American: 44.3%; Chinese: 55.7%), and less than half felt that pain guidelines/protocols were research-based (American: 42.6%; Chinese: 34.9%). Nurses' perceptions of well-managed pain in their units were significantly correlated with adequate education/training, use of accurate tools, and use of research-based protocols. Barriers to effective pain management included resistance to change, lack of knowledge, lack of time, fear of side effects of pain medication, and lack of trust in the tools. The survey reflects concerns that pain has not been well managed in many neonatal intensive care units in the United States and China. Further actions are needed to solve the issues of inadequate training, lack of clinically feasible pain tools, and absence of evidence-based guidelines/protocols.
Snavely, Timothy M
The United States is projected to experience a nursing shortage in the coming years as market forces begin to shift away from equilibrium. A return to pre-recession work levels, aging baby boomers, and insufficient numbers of nursing graduates adversely affect the supply of nurses The aging population, a rise in chronic care management needs, and the Affordable Care Act will result in an increasing demand for them. Returning to a state of equilibrium is critical if our health care system is to ensure care that is accessible, safe, and cost effective.
Weiner, Elizabeth; Irwin, Margaret; Trangenstein, Patricia; Gordon, Jeffry
With concern about bioterrorism and inadequacies in responding to mass casualty events, health care professionals have been placed in the category of first responders. The International Nursing Coalition for Mass Casualty Education (INCMCE) was established to plan strategically to address the educational needs of the nation's nurses. This study sought to determine the types and levels of disaster preparedness curricula being delivered or in development in nursing programs at all levels. INCMCE surveyed 2,013 deans or directors of nursing schools as to curricula for emergency preparedness prior to September 11, 2001, and during the two following academic years. Initial requests were sent via email and the US postal service. Respondents were invited to answer the online survey so data could be directly entered into a database for purposes of data analysis. Responses were received from 348 schools of nursing. Curriculum plans, followed by competency lists, were selected as most helpful for teaching content in disaster preparedness. The survey results validated the general assumption that nursing programs provide limited curricula in this area. The mean number of hours of disaster preparedness content provided, approximately four hours, did not change significantly over three academic years. The study also showed that 75 percent of respondents thought that nurse faculty were inadequately prepared in the area of disaster management. The study established a baseline for future curricular growth.
Godby, Tyler; Saldanha, Sarah; Valle, Jazmine; Paul, David P; Coustasse, Alberto
Nursing home residents across the United States rely on quality care and effective services. Nursing homes provide skilled nurses and nursing aides who can provide services 24 hours a day for individuals who could not perform these tasks for themselves. Not-for-profit (NFP) versus for-profit (FP) nursing homes have been examined for utilization and efficacy; however, it has been shown that NFP nursing homes generally offer higher quality care and generate greater profit margins compared with FP nursing homes. The purpose of this research was to determine if NFP nursing homes provide enhanced quality care and a larger profit margin compared with FP nursing homes. Benefits and barriers in regard to financial stability and quality of care exist for both FP and NFP homes. Based on the findings of this review, it is suggested that NFP nursing homes have achieved higher quality of care because of a more effective balance of business aspects, as well as prioritizing resident well-being, and care quality over profit maximization in NFP homes.
Full Text Available Graduate nursing education in the United States is undergoing major transformations, as a result of factors both within nursing and in the larger society.OBJECTIVE: In this paper the authors examine the trends and factors that are influencing the changes, especially in doctoral education, for both nurse scientist and advanced practice preparation.CONCLUSION: The paper provides a background that serves as context, it gives an overview of the PhD and the DNP degrees, focusing on the recent changes and identifying the most compelling issues and concerns, ending with a series of recommendations.
Susan M Ohlson
Full Text Available Objective: The aim of this study was to describe the emotional intelligence (EI and examine the corresponding demographic characteristics of front-line Nurse Managers in acute care settings. Methods: This quantitative descriptive study was conducted in eight acute care hospitals in the Midwestern United States. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT was used to measure the EI of 87 front-line Nurse Managers. Demographic characteristics of the participants were captured on a second tool, the Nurse Manager Demographic Characteristics questionnaire. Descriptive and inferential statistics were used for analysis. Results: Significant correlations were found between the perceiving and using branches of the model and total EI score and nurses certified in a specialty. No significant correlations were found between EI and graduate education, age, years in management, percentage of time in management or number of direct reports. Considerations for future research are discussed. Conclusions: Opportunity exists to develop EI in front-line Nurse Managers.
Masselink, Leah E; Jones, Cheryl B
Since the 1980s, U.S. policy makers have used immigration policy to influence the supply of nurses by allowing or restricting the entry of internationally educated nurses (IENs) into the U.S. workforce. The methods pursued have shifted over time from temporary visa categories in the 1980s and 1990s to permanent immigrant visas in the 2000s. The impact of policy measures adopted during nursing shortages has often been blunted by political and economic events, but the number and representation of IENs in the U.S. nursing workforce has increased substantially since the 1980s. Even as the United States seeks to increase domestic production of nurses, it remains a desirable destination for IENs and a target market for nurse-producing source countries. Hiring organizations and nurse leaders play a critical role in ensuring that the hiring and integration of IENs into U.S. health care organizations is constructive for nurses, source countries, and the U.S. health care system.
Bloom, J R; Alexander, J A; Nuchols, B A
The objective of this exploratory study was to assess the effects of four nurse staffing patterns on the efficiency of patient care delivery in the hospital: registered nurses (RNs) from temporary agencies; part-time career RNs; RN rich skill mix; and organizationally experienced RNs. Using Transaction Cost Analysis, four regression models were specified to consider the effect of these staffing plans on personnel and benefit costs and on non-personnel operating costs. A number of additional variables were also included in the models to control for the effect of other organization and environmental determinants of hospital costs. Use of career part-time RNs and experienced staff reduced both personnel and benefit costs, as well as total non-personnel operating costs, while the use of temporary agencies for RNs increased non-personnel operating costs. An RN rich skill mix was not related to either measure of hospital costs. These findings provide partial support of the theory. Implications of our findings for future research on hospital management are discussed.
Rome, Vincent; Harris-Kojetin, Lauren D
This report presents national and state estimates of staffing levels in residential care communities for registered nurses, licensed practical or vocational nurses, and aides in the United States for 2014. Data were drawn from the residential care community component of the 2014 wave of the biennial National Study of Long-Term Care Providers, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics. For each staff type, the "staffing level" measure is presented as average hours per resident per day, defined as the total number of hours worked divided by the total number of residents, which does not necessarily reflect the amount of care given to a specific resident. Analyses examined the extent to which residential care community nurse and aide staffing levels varied by selected organizational characteristics and selected resident composition characteristics of the communities. Differences among subgroups were evaluated using two-sided t tests at the 0.05 level. In 2014, the total registered nurse, licensed practical or vocational nurse, and aide staffing level among all residential care communities was about 2 hours and 50 minutes. Registered nurse staffing levels differed for two of the three organizational characteristics (size and metropolitan statistical area [MSA]) and for only one of the four resident composition characteristics (primarily serving residents needing any assistance with activities of daily living). Licensed practical or vocational nurse staffing levels differed for all three organizational characteristics (size, MSA, and ownership) and for only one of the four resident composition characteristics (primarily serving residents diagnosed with Alzheimer’s disease or other dementias). In contrast, differences in aide staffing levels were common when examining both community organizational and resident composition characteristics. Registered nursing, licensed practical and vocational nursing, and aide
Wu, Stacey; Singh-Carlson, Savitri; Odell, Annie; Reynolds, Grace; Su, Yuhua
To examine the experiences of compassion fatigue, burnout, and compassion satisfaction among oncology nurses in the United States and Canada. . Quantitative, descriptive, nonexperimental. . Online survey with members from the Canadian Association of Nursing Oncology and the Oncology Nursing Society. . 486 American and 63 Canadian practicing oncology nurses. . The Professional Quality of Life (ProQOL) scale, version 5, and modified Abendroth Demographic Questionnaire were administered through FluidSurveys™, an online data collection instrument. Chi-square tests of independence were used to investigate associations between demographic characteristics, health, personal stressors, and work-related characteristics to experiences of compassion fatigue, burnout, and compassion satisfaction. Compassion fatigue was measured using the subscales of secondary traumatic stress and burnout. . Compassion fatigue, burnout, and compassion satisfaction. . Demographic characteristics were similar in American and Canadian participants, and both cohorts reported comparable levels of compassion fatigue, burnout, and compassion satisfaction. Perception of team cohesiveness within the workplace environment was found to be significant for both groups, as indicated by significant relationships in all three subscales of secondary traumatic stress, burnout, and compassion satisfaction in the ProQOL. . Healthy and supportive work environments are imperative to nurses' health, well-being, and satisfaction. Improvements in the workplace can help prevent negative sequelae, as well as improve health outcomes for patients and nurses, decrease nurse turnover, and reduce healthcare expenditures. . Findings can be used to implement institutional changes, such as creating policies and guidelines for the development of preventive interventions and psychosocial support for nurses.
Dickinson, George E.
Medical and nursing schools in the United States have traditionally had a limited emphasis on end-of-life care. The present study is a comparison of these 2 professional programs' current offerings on death education. Data were gathered via a mailed survey from the 122 medical schools in 2005 and the 580 baccalaureate nursing programs in 2006.…
Turnipseed, David L.; Turnipseed, Patricia H.
Questionnaires completed by 129 U.S. nurses and 71 from the Philippines revealed higher levels of emotional exhaustion and feelings of personal accomplishment in the United States. The Filipino work environment was rated higher for supervisor support, autonomy, control, and innovation. U.S. nurses reported greater work pressure. (SK)
Burke, Robert E.; Rooks, Sean P.; Levy, Cari; Schwartz, Robert; Ginde, Adit A.
Objectives To identify and describe potentially preventable emergency department (ED) visits by nursing home (NH) residents in the United States. These visits are important because they are common, frequently lead to hospitalization, and can be associated with significant cost to the patient and the health care system. Design Retrospective analysis of the 2005-2010 National Hospital Ambulatory Care Survey (NHAMCS), comparing ED visits by nursing home residents that did not lead to hospital admission (potentially preventable) to those that led to admission (less likely preventable). Setting Nationally representative sample of United States EDs; Federal hospitals and hospitals with less than six beds were excluded. Participants Older (age ≥65 years) nursing home residents with an ED visit during this time period. Measurements Patient demographics, ED visit information including testing performed, interventions (both procedures and medications) provided, and diagnoses treated. Results Older NH residents accounted for 3,857 of 208,956 ED visits during the time period of interest (1.8%). When weighted to be nationally representative, these represent 13.97 million ED visits, equivalent to 1.8 ED visits annually per NH resident in the United States. More than half of visits (53.5%) did not lead to hospital admission; of those discharged from the ED, 62.8% had normal vital signs on presentation and 18.9% did not have any diagnostic testing prior to ED discharge. Injuries were 1.78 times more likely to be discharged than admitted (44.8% versus 25.3%, respectively, p<0.001), while infections were 2.06 times as likely to be admitted as discharged (22.9% versus 11.1%, respectively). CT scans were performed in 25.4% and 30.1% of older NH residents who were discharged from the ED and admitted to the hospital, respectively, and more than 70% of these were CTs of the head. NH residents received centrally acting, sedating medications prior to ED discharge in 9.4% of visits
Nowrouzi, Behdin; Giddens, Emilia; Gohar, Basem; Schoenenberger, Sandrine; Bautista, Mary Christine; Casole, Jennifer
Workplace environment is related to the physical and psychological well-being, and quality of work life (QWL) for nurses. The aim of this paper was to perform a comprehensive literature review on nurses' quality of work life to identify a comprehensive set of QWL predictors for nurses employed in the United States and Canada. Using publications from 2004-2014, contributing factors to American and Canadian nurses' QWL were analyzed. The review was structured using the Work Disability Prevention Framework. Sixty-six articles were selected for analysis. Literature indicated that changes are required within the workplace and across the health care system to improve nurses' QWL. Areas for improvement to nurses' quality of work life included treatment of new nursing graduates, opportunities for continuing education, promotion of positive collegial relationships, stress-reduction programs, and increased financial compensation. This review's findings support the importance of QWL as an indicator of nurses' broader work-related experiences. A shift in health care systems across Canada and the United States is warranted where health care delivery and services are improved in conjunction with the health of the nurses working in the system.
Cioltan, Hannah; Alshehri, Samah; Howe, Carol; Lee, Jeannie; Fain, Mindy; Eng, Howard; Schachter, Kenneth; Mohler, Jane
The use of antipsychotic medications (APMs) in nursing home residents in the U.S. is an increasingly prominent issue and has been associated with increased risk of hospitalization, cardiovascular events, hip fractures, and mortality, among other adverse health events. The Food and Drug Administration has placed a black box warning on these drugs, specifying that they are not meant for residents with dementia, and has asked providers to review their treatment plans. The purpose of this systematic PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-based review was to summarize original research studies on facility level characteristics contributing to the use of antipsychotics in nursing homes across the United States, in order to investigate the variation of use. We searched Ovid Medline, Embase, Cochrane Library, Web of Science, CINAHL, PsycInfo, and Sociological Abstracts. Articles were selected according to the following criteria: (1) Population of interest: older adults (≥60 years of age) residing in nursing homes (not home-based or inpatient hospital settings) in the U.S. (2) Receiving APMs, typical and/or atypical. Specifically excluded were studies of psychotropic medications such as antidepressants, benzodiazepines, anxiolytics, hypnotics, mood stabilizers, and stimulants. All study designs were considered, though reviews, editorials, letters to the editor and opinion pieces were excluded. An expert consultant panel was consulted to categorize facility characteristics into domains and determine possible etiologies of APM use based upon each characteristic. Nineteen observational studies, both quantitative and qualitative, published from 2000 to 2015, met full inclusion criteria and were included in this review. APM use varied based on multiple facility characteristics across several domains: 1) physical, 2) staffing, 3) occupancy, 4) market, and 5) quality. Variation in use of APMs in U.S. nursing homes based upon facility
Mealer, Meredith; Jones, Jacqueline; Moss, Marc
Intensive care unit (ICU) nurses are at increased risk of developing psychological problems including posttraumatic stress disorder (PTSD). However, there are resilient individuals who thrive and remain employed as ICU nurses for many years. The purpose of this study was to identify mechanisms employed by highly resilient ICU nurses to develop preventative therapies to obviate the development of PTSD in ICU nurses. Qualitative study using semi-structured telephone interviews with randomly selected ICU nurses in the USA. Purposive sampling was used to identify ICU nurses who were highly resilient, based on the Connor-Davidson Resilience Scale and those with a diagnosis of PTSD, based on the posttraumatic diagnostic scale. New interviews were conducted until we reached thematic saturation. Thirteen highly resilient nurses and fourteen nurses with PTSD were interviewed (n = 27). A constructivist epistemological framework was used for data analysis. Differences were identified in four major domains: worldview, social network, cognitive flexibility, and self-care/balance. Highly resilient nurses identified spirituality, a supportive social network, optimism, and having a resilient role model as characteristics used to cope with stress in their work environment. ICU nurses with a diagnosis of PTSD possessed several unhealthy characteristics including a poor social network, lack of identification with a role model, disruptive thoughts, regret, and lost optimism. Highly resilient ICU nurses utilize positive coping skills and psychological characteristics that allow them to continue working in the stressful ICU environment. These characteristics and skills may be used to develop target therapies to prevent PTSD in ICU nurses.
Banerjee, Geetanjoli; Zullo, Andrew R.; Berry, Sarah D.; Lee, Yoojin; McConeghy, Kevin; Kiel, Doug P.; Mor, Vincent
Introduction Despite high rates of hip fracture among United States (US) nursing home (NH) residents, little is known about geographic variation in hip fracture incidence. We used nationally representative data to identify geographic variation in hip fracture among US NH residents. Design and setting Retrospective cohort study using Part A claims for a 100% of Medicare enrollees in 15,289 NHs linked to NH minimum data set and Online Survey, Certification, and Reporting databases. Participants A total of 891,085 long-stay (continuous residence of ≥100 days) NH residents ≥65 years old. Measurements Medicare Part A claims documenting a hip fracture. Mean incidence rates of hip fracture for long-stay NH residents were calculated for each state and US Census Division from 2007 to 2010. Results The age-, sex-, and race-adjusted incidence rate of hip fracture ranged from 1.49 hip fractures/100 person-years (Hawaii) to 3.60 hip fractures/100 person-years (New Mexico), with a mean of 2.38 (standard deviation 0.43) hip fractures/100 person-years. The mean incidence of hip fracture was 1.7-fold greater in the highest quintile than the lowest. Conclusions We observed modest US state and regional variation in hip fracture incidence among long-stay NH residents. Future studies should assess whether state policies or NH characteristics explain the variation. PMID:27461867
Hadley, Jo Linda
A study compared the nurse-patient communication of native and non-native English-speaking nurses. Examination of the literature on nurse-patient relationships and a brief survey of native nurses yielded an instrument for observation of nurses. Ten nurses were observed for 3 hourse each. Transcripts of the observations of the five non-native…
Hickey, Patricia A; Gauvreau, Kimberlee; Curley, Martha A Q; Connor, Jean A
This study explored pediatric critical care nursing and organizational factors that impact in-hospital mortality for cardiac surgery patients across children's hospitals in the United States. Congenital heart disease is the most common birth defect and the no. 1 cause of death for infants with a congenital defect. Little is known about the impact of pediatric critical care nursing and organizational factors on pediatric mortality. Nursing leaders from 38 children's hospitals that contribute data to the Pediatric Health Information System data set completed an organizational assessment for years 2009 and 2010. These data were linked with patient-level data. The Risk Adjustment for Congenital Heart Surgery method was used to adjust for baseline patient differences in patients younger than 18 years. The odds of death increased as the institutional percentage of pediatric critical care unit nurses with 2 years' clinical experience or less increased. The odds of mortality were highest when the percentage of RNs with 2 years' clinical experience or less was 20% or greater. The odds of death decreased as the institutional percentage of critical care nurses with 11 years' clinical experience or more increased and for hospitals participating in national quality metric benchmarking. Clinical experience was independently associated with in-hospital mortality. These data are the 1st to link clinical nursing experience with pediatric patient outcomes. A cut point of 20% RNs or greater with 2 years' clinical experience or less was determined to significantly affect inpatient mortality. Participation in national quality metric benchmarking programs was significantly associated with improved mortality.
Praeger, Susan; Zimmerman, Barbara
The purpose of this article is to present a state-by-state summary of rules and regulations governing school nursing practice in the United States. Official government and agency sites were reviewed to determine providers of services in schools, criteria for becoming a school nurse, protection of titling, mandates for school nursing, and the…
Siow, Elaine; Ng, Jeffrey
In the United States, nurses are highly mobile due to a nursing shortage and the transferability of their skills. Despite the importance of internal migration (inter-state movement) of nurses in the distribution of the supply nurses, little is known about such migration. Researchers used data from the 2004 and 2008 National Sample Survey of Registered Nurses to examine the factors associated with nurses' internal migration as well as the difference in job satisfaction for migrant and non-migrant nurses. Factors associated with a higher likelihood of internal migration were: a change in employer, higher earnings, not foreign-educated, less nursing experience, a younger age, being male, being single, having no children, the Nursing Licensure Compact, and not being employed in the state where the first RN license was obtained. Migrant nurses had lower job satisfaction than non-migrant nurses; higher job satisfaction is noted with higher earnings levels. The development of policies such as relocation and social support to help migrant nurses cope and adjust to a new working environment are proposed.
especiai ly critica , on 59 units with thirty or forty patients. On the other hand, ciassification by a charge nurse relieves the staff nurses of...han . a w lirmum 73 costs less, but increases the potential of a staffing crisis if census rises sharply in a short period of time. To arrive a: a
Hye-A Yeom, PhD, RN, ANP-BC
Conclusion: The findings suggest that elders who are exposed to overstimulation in sundowning hours or experience stress from care activities and task performance beyond their baseline competency are likely to be at risk of presenting with CRs. Health care providers need to be aware that a CR is a multi-factorial phenomenon in which multiple contextual antecedents are involved and that creation of a therapeutic physical and social milieu is an important nursing goal in preventing the occurrence of CRs in nursing home residents with dementia. [Asian Nursing Research 2009;3(3:99–110
Full Text Available This paper presents and discusses an integrated set of policies designed to reduce U.S. carbon emissions over the next four decades. This innovation path also aims to promote environmental quality, particularly by reducing emissions of criteria air pollutants, to reduce U.S. dependence on imported oil, and to induce technological innovation and diffusion in energy production and consumption. The innovation path would reduce economy-wide carbon emissions by 26% below baseline projections for 2010 and by 62% below baseline projections for 2030; this translates into 10% below 1990 levels in 2010 and 45% below 1990 levels in 2030. Emissions of criteria pollutants also would be significantly reduced, as would petroleum imports by the United States. Moreover, the innovation path would yield cumulative net savings for the United States of $218 billion (1993 dollars through 2010, or $19 billion on a leveled annual basis, and would result in 800,000 additional jobs nationwide by 2010. Although the overall findings from the innovation path analysis are robust, the results should be taken as indicative, rather than precisely predictive, owing to uncertainties in future costs, prices, technology performance, and consumer behavior.
de Vargas, Divane; Dias,Ana Paula Vieira
This study aimed to estimate the prevalence of depression in nursing staff working in Intensive Care Units of hospitals from a city in Northwestern São Paulo State - Brazil, examining its association with participants' socio-demographic characteristics. The Beck Depression Inventory was applied to a sample of 67 nursing workers from three general hospitals, showing an 28.4% prevalence of depression. The analysis based on the multiple model showed a significant association between depressi...
Squires, Allison; Ojemeni, Melissa T.; Jones, Simon
Background No study has examined the longitudinal trends in National Council Licensure Exam for Registered Nurse (NCLEX-RN) applicants and pass rates among internationally-educated nurses (IENs) seeking to work in the United States, nor has any analysis explored the impact of specific events on these trends, including changes to the NCLEX-RN exam, the role of the economic crisis, or the passing of the WHO Code on the International Recruitment of Health Personnel. This study seeks to understan...
Maas, Lillian Garcia; Ezeobele, Ifeoma Ezebuiro
An international clinical learning experience is a unique opportunity to witness another nursing and healthcare system. The Master of Advanced Nursing Practice (MANP) program at Rotterdam University of Applied Sciences in the Netherlands, mandates an international experience. Semi-structured qualitative interviews, a focus group session and written reflections were used for data collection with 6 Dutch MANP nursing students who specialized in psychiatric mental healthcare. Five major themes were revealed from the data. The themes identified were as follows: (1) pride and passion for mental health profession (2) role diversity within psychiatric mental health nursing (3) nursing leadership at the organization level (4) comparable Westernized approaches to mental healthcare and (5) differences in access to care. Incorporating a mandatory international clinical experience is a beneficial tool to promote a global understanding of the unique advanced practice nursing student's academic and professional development. The international clinical learning experience is considered a highlight of the 2-year MANP program. The students are able to gain a new and broader vision of the APN role and a greater appreciation for the Dutch healthcare system. Copyright © 2014 Elsevier Inc. All rights reserved.
Herzig, Carolyn T. A.; Stone, Patricia W.; Castle, Nicholas; Pogorzelska-Maziarz, Monika; Larson, Elaine L.; Dick, Andrew W.
Objectives The objectives of this study were to (1) obtain a national perspective of the current state of nursing home (NH) infection prevention and control (IPC) programs and (2) examine differences in IPC program characteristics for NHs that had and had not received an infection control deficiency citation. Design A national cross-sectional survey of randomly sampled NHs was conducted and responses were linked with Certification and Survey Provider Enhanced Reporting (CASPER) and NH Compare data. Setting Surveys were completed and returned by 990 NHs (response rate 39%) between December 2013 and December 2014. Participants The person in charge of the IPC program at each NH completed the survey. Measurements The survey consisted of 34 items related to respondent demographics, IPC program staffing, stability of the workforce, resources and challenges, and resident care and employee processes. Facility characteristics and infection control deficiency citations were assessed using CASPER and NH Compare data. Results Most respondents had at least two responsibilities in addition to those related to infection control (54%) and had no specific IPC training (61%). While many practices and processes were consistent with infection prevention guidelines for NHs, there was wide variation in programs across the US. About 36% of responding facilities had received an infection control deficiency citation. NHs that received citations had infection control professionals with less experience (P = .01) and training (P = .02) and were less likely to provide financial resources for continuing education in infection control (P = .01). Conclusion The findings demonstrate that a lack of adequately trained infection prevention personnel is an important area for improvement. Furthermore, there is a need to identify specific evidence-based practices to reduce infection risk in NHs. PMID:26712489
Hutchinson, Alison M.; Draper, Kellie; Sales, Anne E.
While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy. PMID:21037828
Harrington, Charlene; Hauser, Clarilee; Olney, Brian; Rosenau, Pauline Vaillancourt
This study examined the ownership, financing, and management strategies of the 10 largest for-profit nursing home chains in the United States, including the four largest chains purchased by private equity corporations. Descriptive data were collected from Internet searches, company reports, and other sources for the decade 1998-2008. Since 1998, the largest chains have made many changes in their ownership and structure, and some have converted from publicly traded companies to private ownership. This study shows the increasing complexity of corporate nursing home ownership and the lack of public information about ownership and financial status. The chains have used strategies to maximize shareholder and investor value that include increasing Medicare revenues, occupancy rates, and company diversification, establishing multiple layers of corporate ownership, developing real estate investment trusts, and creating limited liability companies. These strategies enhance shareholder and investor profits, reduce corporate taxes, and reduce liability risk. There is a need for greater transparency in ownership and financial reporting and for more government oversight of the largest for-profit chains, including those owned by private equity companies.
Broome, Marion E
Over the past decade there has been a lack of attention in the discipline paid to developing strong academic leaders. It is widely acknowledged that the role of the dean has shifted dramatically over the past two decades, with an increasing emphasis on interaction with and accountability to external constituencies at the university, community, and national levels. The overall purpose of this study was to investigate the self-reported leadership styles, behaviors, and experiences of deans of schools of nursing in the United States. The Multifactor Leadership Questionnaire (MLQ) was sent to 655 deans who were members of the American Association of Colleges of Nursing; 344 returned completed surveys for a return rate of 52.5%. Scores on the transformational scale (n = 321; 20 items) ranged from 2.75 to 4.0, with a mean of 3.79; transactional scores ranged from 1.3 to 4.0, with a mean of 3.3 and mode of 3.5. The passive leadership component was lowest, with a range of 0 to 3.75, mean of 1.1, and mode of 1.0. The highest scores for each dean were then examined and compared across the three components. Seventy-seven percent of the deans' highest scores fell on the transformational, 21% on the transactional, and 2% on the passive-avoidant scale. There were no significant differences in the most commonly reported leadership behaviors by gender, ethnicity, or terminal degree. Deans of nursing, compared with over 3,000 other leaders who have completed the MLQ, ranked in the 80th percentile for self-reported transformative behaviors and outcomes effectiveness. The findings from this sample, who were predominantly female, are congruent with previous research on women leaders. Recommendations for future research leadership development programs are presented.
Hetteberg, Carol G.; Prows, Cynthia A.; Deets, Carol; Monsen, Rita B.; Kenner, Carole A.
A sample of 879 basic nursing programs was used to identify the type and amount of genetics content in curricula. Recommendations were made for increasing genetics content as a result of the synthesis of the survey data with previously collected data. (25 references) (Author/JOW)
Resnick, Helaine E.; Manard, Barbara B.; Stone, Robyn I.; Alwan, Majd
Objectives This study sought to define the extent of utilization of 12 types of electronic information system (EIS) function in U.S. nursing homes (NH), to relate EIS utilization to selected facility characteristics and to contrast these findings to previous estimates of EIS use in NH. Design This study used data from the National Nursing Home Survey (NNHS), a nationally representative, cross-sectional sample of U.S. NH. Measurements Data on current use of EIS in 12 functional areas, including administrative and resident care activities, were collected. Information was also collected on facility characteristics including ownership, bed size, and whether the facility was a member of a chain. Results Essentially all (99.6%) U.S. NH had ≥1 EIS, a figure that was driven by the nearly universal use of EIS for Minimum Data Set (MDS) reporting (96.4%) and for billing (95.4%). Nearly 43% of U.S. NH had EIS for medical records, including nurse's notes, physician notes, and MDS forms. EIS use ranged from a high of 79.6% for admission, transfer, and discharge to a low of 17.6% for daily care by certified nursing assistants (CNAs). Ownership, membership in a chain, and bed size were associated with use of selected EIS. Larger facilities and those that were part of a chain used more EIS than smaller standalone facilities. Conclusion In 2004, NH use of EIS for functions other than MDS and billing was highly variable, but considerably higher than previous estimates. PMID:18952930
Temkin-Greener, Helena; Zheng, Nan Tracy; Xing, Jingping; Mukamel, Dana B.
Context The proportion of US deaths occurring in nursing homes (NHs) has been increasing in the last two decades and is expected to reach 40% by 2020. Despite being recognized as an important setting in the provision of end-of-life care (EOL), little is known about the quality of care provided to dying NH residents. There has been some, but largely anecdotal evidence suggesting that many US NHs transfer dying residents to hospitals, in part to avoid incurring the cost of providing intensive on-site care, and in part because they lack resources to appropriately serve the dying residents. We assessed longitudinal trends and geographic variations in place of death among NH residents, and examined the association between residents’ characteristics, treatment preferences, and the probability of dying in hospitals. Methods We used the Minimum Data Set (NH assessment records), Medicare denominator (eligibility) file, and Medicare inpatient and hospice claims to identify decedent NH residents. In CY2003–2007, there were 2,992,261 Medicare eligible nursing home decedents from 16,872 US Medicare and/or Medicaid certified NHs. Our outcome of interest was death in NH or in a hospital. The analytical strategy included descriptive analyses and multiple logistic regression models, with facility fixed effects, to examine risk-adjusted temporal trends in place of death. Findings Slightly over 20% of decedent NH residents died in hospitals each year. Controlling for individual level risk factors and for facility fixed effects, the likelihood of residents dying in hospitals has increased significantly each year between 2003 through 2007. Conclusions This study fills a significant gap in the current literature on EOL care in US nursing homes by identifying frequent facility-to-hospital transfers and an increasing trend of in-hospital deaths. These findings suggest a need to rethink how best to provide care to EOL nursing home residents. PMID:23664483
Miller, Ted R.
Nurse-Family Partnership (NFP) targets intensive prenatal and postnatal home visitation by registered nurses to low-income first-time mothers. Through 2013, 177,517 pregnant women enrolled in NFP programs. This article projects how NFP will affect their lives and the lives of their babies. NFP has been evaluated in six randomized trials and several more limited analyses of operational programs. We systematically reviewed evaluation findings on 21 outcomes and calculated effects on 3 more. We added outcome data from the NFP national data system and personal communications that filled outcome data gaps on some trials. We assumed effectiveness in replication declined by 21.8%, proportionally with the decline in mean visits per family from trials to operational programs. By 2031, NFP program enrollments in 1996-2013 will prevent an estimated 500 infant deaths, 10,000 preterm births, 13,000 dangerous closely spaced second births, 4,700 abortions, 42,000 child maltreatment incidents, 36,000 intimate partner violence incidents, 90,000 violent crimes by youth, 594,000 property and public order crimes (e.g., vandalism, loitering) by youth, 36,000 youth arrests, and 41,000 person-years of youth substance abuse. They will reduce smoking during pregnancy, pregnancy complications, childhood injuries, and use of subsidized child care; improve language development, increase breast-feeding, and raise compliance with immunization schedules. They will eliminate the need for 4.8 million person-months of child Medicaid spending and reduce estimated spending on Medicaid, TANF, and food stamps by $3.0 billion (present values in 2010 dollars). By comparison, NFP cost roughly $1.6 billion. Thus, NFP appears to be a sound investment. It saves money while enriching the lives of participating low-income mothers and their offspring and benefiting society more broadly by reducing crime and safety net demand. PMID:26076883
de Vargas, Divane; Dias, Ana Paula Vieira
This study aimed to estimate the prevalence of depression in nursing staff working in Intensive Care Units of hospitals from a city in Northwestern São Paulo State - Brazil, examining its association with participants' socio-demographic characteristics. The Beck Depression Inventory was applied to a sample of 67 nursing workers from three general hospitals, showing an 28.4% prevalence of depression. The analysis based on the multiple model showed a significant association between depression and marital status (OR=1.52), night work (OR=1.46) and double shifts (OR=2.11). Also, there were significant percentages of workers who reported discouragement, sadness and hopelessness. In conclusion, the prevalence of depression is significant and more attention should be paid to this problem workers at these units face. Further studies are needed in the attempt to broaden knowledge on the subject, which can support strategies to guarantee attention to ICU nursing workers' physical and mental health needs.
Alb, Caitrin H; Theall, Katherine; Jacobs, Marni B; Bales, Ana
The U.S. Federal Reasonable Break Time for Nursing Mothers Law to support breastfeeding employees was passed in 2010, as part of the Affordable Care Act. However, few data are available assessing employers' awareness of the law or its implementation. The study aims were to 1) describe New Orleans employers' awareness of the law, 2) determine the extent of the law implementation within workplaces, and 3) determine the associations between workplace characteristics and employers' awareness and implementation. A cross-sectional survey was mailed to 652 workplaces with more than 50 employees in New Orleans, Louisiana, in the fall of 2013. A random sample of those who did not respond was called. The survey included questions about the industry category, number and type of employees, the employers' awareness of the law, if they had begun to implement the law, and their perceptions of barriers to implementation. The final sample included 182 workplaces (27.9% response rate). Eighty-seven participants (47.8%) reported having heard of the law. However, 52.7% of the participants (n = 96) responded that they had begun to implement the law. Large workplaces (≥100 employees) were more than four times as likely to be aware of the law compared with smaller workplaces (odds ratio, 4.23; 95% confidence interval, 1.69-10.59). The results were similar for beginning implementation. The proportion of large workplaces who are aware of the law remains lower than it should be, even 3 years after the institution of the Affordable Care Act. Outreach to all workplaces, including smaller ones, is needed to inform employers about the law and give them tools for implementation. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Teel, Cynthia S; Shaw, Judith A
This project had a dual purpose: 1) to facilitate student learning about qualitative research methods, and 2) to promote collegiality and professional development among senior nursing students in Canada and the United States through the use of distance technology. In each of three project years, students at St. Francis Xavier University (STFX) in Nova Scotia initiated the experience by working in small groups to develop websites about different methodological approaches in qualitative research. Site information included an overview of the selected approach, discussion of trustworthiness issues, citation of journal articles in which authors used the approach, additional references, and some personal information about the student developers. Also working in small groups, University of Kansas students identified and read related research articles, reviewed website information, and responded to the STFX groups about the usefulness of site information in increasing understanding of qualitative methods and using the information for evaluation of research. The experience promoted active use of qualitative research concepts and facilitated the development of skills in evaluating research article content and website content. Participation in the activity fostered positive perceptions about the value and use of research and helped students appreciate the similarities in courses, programs, and professional requirements and values among international peers.
Brown, Jennifer F
The nursing department at Norfolk State University (NSU), a historically Black university located in Norfolk, Virginia, designed a program to increase the retention and success of foreign-born students challenged with English as a Second Language (ESL). Through strategies designed to address language, social, academic, and personal challenges, the program has led to improvements in student satisfaction and performance. This article reviews the literature related to educating foreign-born nursing students in the United States, discusses unique considerations for these students within minority-serving institutions, describes key components of program development, and evaluates NSU's program. To increase the diversity of the nursing workforce, other institutions are encouraged to consider replicating NSU's model for ESL-student retention and success.
deployed in field hospitals and must be well versed in the management of trauma (Bellamy, 1995 ). To this end, the anesthesia provider needs to be trained...result of aggression encountered during peacekeeping missions such as those recently undertaken. Bellamy ( 1995 ) has shown that ninety percent of combat...Flavel, Brown, Schon, Spiro and Vygotsky . In this model, McAulife states that the best way to learn and instruct others is by a method of case based
Espino, David V.; Angel, Jaqueline L.; Wood, Robert C.; Finely, M. Rosina; Ye, Y.
Objectives The purpose of the current study is to describe the factors associated with Mexican American elders who have spent time in a SNF compared to those who have not in the Southwestern United States. Design Data were collected on the Mexican American elders who reported a SNF stay within 10 years of baseline. Participants A probability sample of 3050 Mexican American elders from five Southwestern states followed from 1993 to 2005 were examined. Measures Variables examined included socio-demographics, language of interview, disabilities with Instrumental Activities of Daily Living (IADLs), Activities of Daily Living (ADLs), selfreported health, cognitive status and depression. Results A total of 78 (3.9%) out of 2020 subjects resided in SNF’s. Using univariate analyses older age, English-language interview, poorer cognitive status, and functional disabilities were independently associated with Skilled Nursing Facility (SNF) admissions. Logistic regression analyses controlling for age reveal that SNF patients were older (OR =1.08, p=0.001), have an ADL disability (OR=4.94, p<0.001), scored in the Geriatric Depression Scale depressed range (OR=2.72, p=0.001) and were more likely to interview in English (OR=1.95, p=0.042), when compared to community counterparts. Conclusions Mexican American elders resided in a SNF at some point in the previous ten years were older and more likely to be functionally impaired. They also were more likely to prefer English as their primary language indicating they were more likely to agree to a SNF stay than their Spanish speaking counterparts. PMID:23352979
Gazza, Elizabeth A; Shellenbarger, Teresa; Hunker, Diane F
Graduates of doctoral nursing programs are expected to disseminate knowledge through scholarly writing, yet faculty teaching doctoral nursing students in two specific programs in western Pennsylvania in the United States noted students enter their doctoral programs with varying writing skills. The purpose of this hermeneutic phenomenological study was to uncover the lived experience of developing as a scholarly writer. Data were collected through the use of a demographic questionnaire and personal interviews with 10 students enrolled in their first semester of coursework in a traditional, rather than online, 60-credit PhD in nursing program at a large state university in western Pennsylvania. All interviews were recorded and transcribed and served as rich data sources. Data were analyzed using a systematic approach consistent with hermeneutic phenomenology. Themes uncovered included (a) coming to know about scholarly writing, (b) shifting thinking in order to write scholarly, (c) giving birth: the pain and the pleasure of scholarly writing, and (d) putting all the pieces together into the final product. Findings from this study can help faculty to understand the experiences of nursing student scholarly writing development. Recommendations based on the findings include a collection of teaching strategies that can be used to facilitate scholarly writer development across all levels of nursing education.
Boyer, Cheryl M.
Discusses the accreditation and evolution of continuing education programs developed by state nurses' associations and other nursing organizations and the value of the accreditation. Also relates current accreditation system to the future of professional continuing education. (JOW)
Ferreira, Tadeu Sartini; Moreira, Clarice Zinato; Guo, James; Noce, Franco
To assess the effect of a 12-hour shift on mood states and sleepiness at the beginning and end of the shift. Quantitative, cross-sectional and descriptive study.It was conducted with 70 neonatal intensive care unit nurses. The Brunel Mood Scale (BRUMS), Karolinska Sleepiness Scale (KSS), and a socio-demographic profile questionnaire were administered. When the KSS and BRUMS scores were compared at the beginning of the shift associations were found with previous sleep quality (p ≤ 0.01), and quality of life (p ≤ 0.05). Statistical significant effects on BRUMS scores were also associated with previous sleep quality, quality of life, liquid ingestion, healthy diet, marital status, and shift work stress. When the beginning and end of the shift were compared, different KSS scores were seen in the group of all nurses and in the night shift one. Significant vigor and fatigue scores were observed within shift groups. A good night's sleep has positive effects on the individual`s mood states both at the beginning and the end of the shift. The self-perception of a good quality of life also positively influenced KSS and BRUMS scores at the beginning and end of the shift. Proper liquid ingestion led to better KSS and BRUMS scores. Evaluar el efecto de un turno de 12 horas en estados de ánimo y somnolencia al principio y al final del turno. Estudio cuantitativo, transversal y descriptivo.Se realizó con 70 enfermeras de unidades de cuidados intensivos neonatales. Se administró la Escala de Humor Brunel (BRUMS), la Escala de Somnolencia de Karolinska (KSS) y un cuestionario de perfil sociodemográfico. Cuando se compararon las puntuaciones de KSS y BRUMS al comienzo del turno se encontraron asociaciones con calidad de sueño previa (p ≤ 0,01) y calidad de vida (p ≤ 0,05). Los efectos estadísticos significativos en las puntuaciones de BRUMS también se asociaron con la calidad previa del sueño, la calidad de vida, la ingestión de líquidos, la dieta saludable, el
Mazurenko, O; Gupte, G; Shan, G
This study examined the education and work experience of immigrant and American-trained registered nurses from 1988 to 2008. The USA increasingly relies on immigrant nurses to fill a significant nursing shortage. These nurses receive their training overseas, but can obtain licenses to practice in different countries. Although immigrant nurses have been in the USA workforce for several decades, little is known about how their education and work experience compares with USA-trained nurses. Yet much is presumed by policy makers and administrators who perpetuate the stereotype that immigrant nurses are not as qualified. We analysed the National Sample Survey of Registered Nurses datasets from 1988 to 2008 using the Cochran-Armitage trend tests. Our findings showed similar work experience and upward trends in education among both groups of nurses. However, American-trained nurses were more likely to further advance their education, whereas immigrant nurses were more likely to have more work experience and practice in a wider range of healthcare settings. Although we discovered differences between nurses trained in the USA and abroad, we theorize that these differences even out, as education and work experience each have their own distinct caregiving advantages. Immigrant nurses are not less qualified than their American-trained counterparts. However, healthcare providers should encourage them to further pursue their education and certifications. Even though immigrant nurses' education and work experience are comparable with their American counterparts, workforce development policies may be particularly beneficial for this group. © 2014 International Council of Nurses.
Bratt, M M; Broome, M; Kelber, S; Lostocco, L
High levels of stress and the challenges of meeting the complex needs of critically ill children and their families can threaten job satisfaction and cause turnover in nurses. To explore the influences of nurses' attributes, unit characteristics, and elements of the work environment on the job satisfaction of nurses in pediatric critical care units and to determine stressors that are unique to nurses working in pediatric critical care. A cross-sectional survey design was used. The sample consisted of 1973 staff nurses in pediatric critical care units in 65 institutions in the United States and Canada. The following variables were measured: nurses' perceptions of group cohesion, job stress, nurse-physician collaboration, nursing leadership, professional job satisfaction, and organizational work satisfaction. Significant associations (r = -0.37 to r = -0.56) were found between job stress and group cohesion, professional job satisfaction, nurse-physician collaboration, nursing leadership behaviors, and organizational work satisfaction. Organizational work satisfaction was positively correlated (r = 0.35 to r = 0.56) with group cohesion, professional job satisfaction, nurse-physician collaboration, and nursing leadership behaviors. Job stress, group cohesion, job satisfaction, nurse-physician collaboration, and nursing leadership behaviors explained 52% of the variance in organizational work satisfaction. Dealing with patients' families was the most frequently cited job stressor. Job stress and nursing leadership are the most influential variables in the explanation of job satisfaction. Retention efforts targeted toward management strategies that empower staff to provide quality care along with focal interventions related to the diminishment of stress caused by nurse-family interactions are warranted.
Kronenfeld, Michael; Stephenson, Priscilla L.; Nail-Chiwetalu, Barbara; Tweed, Elizabeth M.; Sauers, Eric L.; McLeod, Tamara C. Valovich; Guo, Ruiling; Trahan, Henry; Alpi, Kristine M.; Hill, Beth; Sherwill-Navarro, Pamela; Allen, Margaret (Peg); Stephenson, Priscilla L.; Hartman, Linda M.; Burnham, Judy; Fell, Dennis; Kronenfeld, Michael; Pavlick, Raymond; MacNaughton, Ellen W.; Nail-Chiwetalu, Barbara
Objective: This paper provides an overview of the state of evidence-based practice (EBP) in nursing and selected allied health professions and a synopsis of current trends in incorporating EBP into clinical education and practice in these fields. This overview is intended to better equip librarians with a general understanding of the fields and relevant information resources. Included Professions: Professions are athletic training, audiology, health education and promotion, nursing, occupational therapy, physical therapy, physician assisting, respiratory care, and speech-language pathology. Approach: Each section provides a description of a profession, highlighting changes that increase the importance of clinicians' access to and use of the profession's knowledgebase, and a review of each profession's efforts to support EBP. The paper concludes with a discussion of the librarian's role in providing EBP support to the profession. Conclusions: EBP is in varying stages of growth among these fields. The evolution of EBP is evidenced by developments in preservice training, growth of the literature and resources, and increased research funding. Obstacles to EBP include competing job tasks, the need for additional training, and prevalent attitudes and behaviors toward research among practitioners. Librarians' skills in searching, organizing, and evaluating information can contribute to furthering the development of EBP in a given profession. PMID:17971887
Duffield, Christine M; Roche, Michael A; Blay, Nicole; Stasa, Helen
This paper examined the impact of leadership characteristics of nursing unit managers, as perceived by staff nurses, on staff satisfaction and retention. A positive work environment will increase levels of job satisfaction and staff retention. Nurse leaders play a critical role in creating a positive work environment. Important leadership characteristics of the front-line nurse manager include visibility, accessibility, consultation, recognition and support. Secondary analysis of data collected on 94 randomly selected wards in 21 public hospitals across two Australian states between 2004-2006. All nurses (n = 2488, 80·3% response rate) on the selected wards were asked to complete a survey that included the 49-item Nursing Work Index-Revised [NWI-R] together with measures of job satisfaction, satisfaction with nursing and intention to leave. Subscales of the NWI-R were calculated. Leadership, the domain of interest, consisted of 12 items. Wards were divided into those reporting either positive or negative leadership. Data were analysed at the nurse level using spss version 16. A nursing manager who was perceived to be a good leader, was visible, consulted with staff, provided praise and recognition and where flexible work schedules were available was found to distinguish the positive and negative wards. However, for a ward to be rated as positive overall, nurse leaders need to perform well on all the leadership items. An effective nursing unit manager who consults with staff and provides positive feedback and who is rated highly on a broad range of leadership items is instrumental in increasing job satisfaction and satisfaction with nursing. Good nurse managers play an important role in staff retention and satisfaction. Improved retention will lead to savings for the organisation, which may be allocated to activities such as training and mentorship to assist nurse leaders in developing these critical leadership skills. Strategies also need to be put in place to
... a CDC Malaria Branch clinician. email@example.com Malaria Treatment (United States) Recommend on Facebook Tweet Share Compartir Treatment of Malaria: Guidelines For Clinicians (United States) Download PDF version ...
penetrating wound of brain " (United States Department of Defense, 1987, p. 182). Since it was virtually impossible to construct one question covering...exhaustion is characterized by which of the following? a. Euphoria, sharpened skills and senses b. Insomnia, anorexia , and malaise c. Unrelenting fatigue... malnutrition d. Don’t know 11. An external fixation device to immobilize a fractured extremity is best described by which of the following? a. A special cast
Wihlborg, Monne; Friberg, Elizabeth
A sound pedagogical framework must be explored and identified to implement opportunities for collaborative learning through international exchange. This paper identifies the framework used by two universities, in Sweden and the United States. Virtual learning environments and meaningful learning activities can be constructed using web-based learning platforms. The goal for this initiative was 'internationalisation on home plan' for nursing faculty and students that opened up internationalised learning opportunities for all students, including those who do not participate in study abroad/mobility activities. This broader opportunity supports the development of cultural awareness and understanding of global health care practices and the nursing profession on mutual topics of concern, in this case patient safety. Learning activities and learning outcomes can be stipulated. The pedagogical framework was compatible with the Bologna Process' constructive alignment, deep learning and a student focus. The student nurses were not only given the opportunity to explore the learning objective of patient safety and participate in an international collaboration with another university, but also gained university academic credit for fulfilling the task. There is a great gain in using virtual collaboration and learning modules that are embedded in courses for the purpose of 'internationalisation on home plan' since not all students can participate in student mobility activities.
Kim-Godwin, YeounSoo; McMurry, Megan J
The purpose of this study was to explore perspectives of nurse practitioners on health care needs among Latino children and families in the rural Southeastern United States. This qualitative research used semi-structured interviews with seven nurse practitioners (NPs) practicing in the rural southeastern part of North Carolina. Flanagan's critical incident technique was used to describe the experiences of NPs providing health care for Latino children and parents. Data analysis indicates that the most commonly reported illnesses by Latino children are upper respiratory infections and asthma, followed by otitis media, obesity, anemia, pneumonia, leukemia, and tumors. Barriers to health care for children included language and cultural differences, lack of access to care (e.g., lack of insurance, cost, and transportation), and health illiteracy/low education level of parents. The findings also suggest that Latinos are preserving their traditional health practices when treating their children's illnesses, such as through use of foods, hot/cold items, herbs, coin on "belly button," traditional juices, healing bracelets, and evil eye. The findings of the study imply the need to incorporate culturally sensitive care when providing care for Latino children and parents. Copyright © 2012 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.
Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick
In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.
Dikken, Jeroen; Hoogerduijn, Jita G; Klaassen, Sharon; Lagerwey, Mary D; Shortridge-Baggett, Lillie; Schuurmans, Marieke J
The Knowledge about Older Patients-Quiz (KOP-Q) is designed as a unidimensional scale measuring knowledge of hospital nurses about older patients. Furthermore, the KOP-Q measures a second unidimensional construct, certainty of hospital nurses about their knowledge. The KOP-Q is developed and validated in the Netherlands. Whether the KOP-Q can be used in other countries is unknown given the cultural and language differences. Investigate the level of measurement invariance of the KOP-Q between the Netherlands and United States of America (USA). A multicenter international cross-sectional design. Four general hospitals in the Netherlands and four general hospitals in the USA. Nurses from the Netherlands (n=201) and the USA (n=130) were invited to participate by email from the ward manager, distributing flyers and present messages on the online hospital communication boards. Questions of the KOP-Q were completed online. The level of measurement invariance (configural, metric or scalar invariance) across countries was tested by running increasingly constrained structural equation models, and testing whether these models fitted the data. Both the knowledge and certainty construct of the KOP-Q proved unidimensional in the Netherlands and USA sample. Test results of the measurement invariance across the Netherlands and USA indicated a stable, partial scalar invariance (15 items full scalar invariance) for the knowledge items and full scalar invariance for the certainty items. The KOP-Q shows to function uniformly across both language groups and can therefore be used to assess nurses' knowledge and their certainty about this knowledge which can be important for educational and/or quality improvement programs in the USA. Furthermore, the KOP-Q is suitable to make comparisons between the Netherlands and the USA using latent variable models. Before the KOP-Q can be used in other countries, cross-cultural tests should again be performed. Copyright © 2017 Elsevier Ltd. All
Panunto, Marcia Raquel; Guirardello, Edinêis de Brito
One of the biggest challenges nurses face is the need to justify the quantity and quality of staff for care delivery. For this, management instruments are available which help them to determine the staff needed in the nursing team. This descriptive study aims to evaluate the nursing workload at a specialized clinical and surgical gastroenterology unit. To collect data, the Nursing Activities Score (NAS) was used during 30 consecutive days, with 1080 comments, obtained from the records of 149 patients. The mean NAS score was 34.9% and, considering that each point of NAS corresponds to 0.24 hour, on the average, 8.4 hours of nursing care were required within 24 hours. This means that this profile is of patients who demand intermediate and semi-intensive care, which suggests that the NAS study can be used to evaluate the workload of nurses at that unit.
Kumaş, Gülşah; Oztunç, Gürsel; Nazan Alparslan, Z
This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. In some specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011).
Wyman, Jean F; Henly, Susan J
Preparing nursing doctoral students with knowledge and skills for developing science, stewarding the discipline, and educating future researchers is critical. This study examined the content of 120 U.S. PhD programs in nursing as communicated on program websites in 2012. Most programs included theory, research design, and statistics courses. Nursing inquiry courses were evidenced on only half the websites. Course work or research experiences in informatics were mentioned on 22.5% of the websites; biophysical measurement and genetics/genomics were mentioned on fewer than 8% of program websites. Required research experiences and instruction in scientific integrity/research ethics were more common when programs had Institutional Training Award funding (National Institutes of Health T32 mechanism) or were located at a university with a Clinical and Translational Science Award. Changes in education for the next generation of PhD students are critically needed to support advancement of nursing science. Copyright © 2015 Elsevier Inc. All rights reserved.
Thomas-Hawkins, Charlotte; Flynn, Linda; Clarke, Sean P
Little attention has been given to the effects of registered nurse (RN) staffing and processes of nursing care on patient outcomes in hemodialysis units. This research examined the effects of patient-to-RN ratios and necessary tasks left undone by RNs on the likelihood of nurse-reported frequent occurrences of adverse patient events in chronic hemodialysis units. Study findings revealed that high patient-to-RN ratios and increased numbers of tasks left undone by RNs were associated with an increased likelihood of frequent occurrences of dialysis hypotension, skipped dialysis treatments, shortened dialysis treatments, and patient complaints in hemodialysis units. These findings indicate that federal, state, and dialysis organization policies must foster staffing structures and processes of care in dialysis units that effectively utilize the invaluable skills and services of professional, registered nurses.
Tyson, Donald Lee
This qualitative study explores the critical thinking experiences of African nursing students enrolled in several universities in the U.S. Using a semi-structured interview approach, twelve African students discussed their experiences using and learning a western critical thinking approach, as well as described their educational experiences in…
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 535.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof including the Trust Territory...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 515.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including the Trust Territory...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 500.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including U.S. trust...
1Neonatal intensive care unit at Rwanda Military Hospital. 2University of ... Keywords: Nurse; nursing practice; leadership; management; caring; competencies; holistic nursing ... indicators of a profession's advancement or lack thereof.
Lima, Rogério Silva; Lourenço, Eliana Bernardes; Rosado, Sara Rodrigues; Fava, Silvana Maria Coelho Leite; Sanches, Roberta Seron; Dázio, Eliza Maria Rezende
Objective To understand the meanings that nursing staff gives to nurse's managerial practice in the inpatient unit. Methods This is an exploratory and descriptive research with qualitative approach, conducted in a general hospital in a Southern city of Minas Gerais State. We used the Theory of Social Representations as theoretical framework. The study sample were composed by 23 nursing technicians and five nursing assistants. Data collection was conducted through semi-structured interviews, from December 2011 to January 2012. For data analysis we used the discourse analysis, according to social psychology framework. Results The meanings attributed to management occurred from the closeness/distance to staff and to patients` care actions. Conclusions The managerial nurse, perceived as a process apart from care, is classified as non familiar practice, of hard understanding and valuation.
Berceda, 572 F.2d 630 (9th Cir. 1978).. A mere request, such as that made by the defendant, is not sufficient; United States v. Trejo- Zambrano , 582 F.2d...a mere request and more than mere speculation that disclosure will be helpful. United States v. Trejo- Zambrano , 582 F.2d 460 (9th Cir. 1978), eect. dt...both known and unknown to the Grand Jury, including Lane Boudreau, Scott Willard Holland, James Allen Halperin, Maria Ximena Erlandsen, Derek Adrian
Decker, Frederic H
Poorer resident care in US for-profit relative to not-for-profit nursing homes is usually blamed on the profit motive. But US nursing home performance may relate to Medicaid public financing in a manner qualifying the relationship between ownership and quality. We investigated effects of Medicaid resident census, Medicaid payment, and occupancy on performance. Resource dependence theory implies these predictors may affect discretion in resources invested in resident care across for-profit and not-for-profit facilities. Models on physical restraint use and registered nurse (RN) staffing were studied using generalized estimating equations with panel data derived from certification inspections of nursing homes. Restraint use increased and RN staffing levels decreased among for-profit and not-for-profit facilities when the Medicaid census increased and Medicaid payment decreased. Interaction effects supported a theory that performance relates to available discretion in resource allocation. Effects of occupancy appear contingent on the dependence on Medicaid. Poorer performance among US for-profit nursing homes may relate to for-profit homes having lower occupancy, higher Medicaid census, and operating in US states with lower Medicaid payments compared to not-for-profit homes. Understanding the complexity of factors affecting resources expended on resident care may further our understanding of the production of quality in nursing homes, whether in the US or elsewhere.
Truppel, Thiago Christel; Meier, Marineli Joaquim; Calixto, Riciana do Carmo; Peruzzo, Simone Aparecida; Crozeta, Karla
This is a methodological research, which aimed at organizing the systematization of nursing assistance in a critical care unit. The following steps were carried out: description of the nursing practice; transcription of nursing diagnoses; elaboration of a protocol for nursing diagnosis based in International Classification for Nursing Practice (ICNP); determination of nursing prescriptions and the elaboration of guidelines for care and procedures. The nursing practice and care complexity in ICU were characterized. Thus, systematization of nursing assistance is understood as a valuable tool for nursing practice.
Roots, Angela; Thomas, Libby; Jaye, Peter; Birns, Jonathan
National clinical guidelines have emphasized the need to identify acute stroke as a clinical priority for early assessment and treatment of patients on hyperacute stroke units. Nurses working on hyperacute stroke units require stroke specialist training and development of competencies in dealing with neurological emergencies and working in multidisciplinary teams. Educational theory suggests that experiential learning with colleagues in real-life settings may provide transferable results to the workplace with improved performance. Simulation training has been shown to deliver situational training without compromising patient safety and has been shown to improve both technical and non-technical skills (McGaghie et al, 2010). This article describes the role that simulation training may play for nurses working on hyperacute stroke units explaining the modalities available and the educational potential. The article also outlines the development of a pilot course involving directly relevant clinical scenarios for hyperacute stroke unit patient care and assesses the benefits of simulation training for hyperacute stroke unit nurses, in terms of clinical performance and non-clinical abilities including leadership and communication.
Holmes, Dave; Federman, Cary
The aim of this article is to bring to the attention of the international nursing community the discrepancy between a pervasive 'caring' nursing discourse and a most unethical nursing practice in the United States. In this article, we present a duality: the conflict in American prisons between nursing ethics and the killing machinery. The US penal system is a setting in which trained healthcare personnel practice the extermination of life. We look upon the sanitization of deathwork as an application of healthcare professionals' skills and knowledge and their appropriation by the state to serve its ends. A review of the states' death penalty statutes shows that healthcare workers are involved in the capital punishment process and shielded by American laws (and to a certain extent by professional boards through their inaction). We also argue that the law's language often masks that involvement; and explain how states further that duplicity behind legal formalisms. In considering the important role healthcare providers, namely nurses and physicians, play in administering death to the condemned, we assert that nurses and physicians are part of the states' penal machinery in America. Nurses and physicians (as carriers of scientific knowledge, and also as agents of care) are intrinsic to the American killing enterprise. Healthcare professionals who take part in execution protocols are state functionaries who approach the condemned body as angels of death: they constitute an extension of the state which exercises its sovereign power over captive prisoners.
Full Text Available Michael A Roche,1 Christine Duffield,1,2 Sofia Dimitrelis,1 Belinda Frew1 1Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, NSW, 2Clinical Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia Aim: To examine specific elements of nursing leadership linked to intention to leave, in public acute care hospitals. Background: Nurse turnover is a global issue receiving widespread attention due to prolonged and projected workforce shortages. Nurse management and leadership qualities have been associated with intention to leave and turnover of nurses. The role of the nurse unit managers in the retention of nurses is becoming increasingly important, particularly because of their strong influence on the quality and stability of the work environment. Methods: Data were collected from 62 medical, surgical, and mixed units across eleven public acute care hospitals in three Australian states (September 2008 to August 2010. A total of 1,673 nurses completed a nurse survey that included measures of intention to leave and leadership aspects of the practice environment. Analyses explored specific leadership characteristics that were associated with turnover intent. Results: The role of nursing unit managers was confirmed to be a major factor in nurses’ intention to remain or leave their current workplace. Nurses valued “human” skills more highly than other leadership characteristics, including their manager’s connection with nurses’ concerns, clarity, participation in decisions, and encouragement. Conclusion: Strong leadership qualities in the nursing unit manager have been associated with greater job satisfaction, reduced turnover intention among nursing staff, and improved patient outcomes. Nurse leaders need to be supported in an effort to retain nurses given ongoing workforce issues and to ensure high-quality patient care. Keywords: nurse
Aiken, L.H.; Sermeus, W.; Heede, K. Van den; Sloane, D.M.; Busse, R.; McKee, M.; Bruyneel, L.; Rafferty, A.M.; Griffiths, P.; Moreno-Casbas, M.T.; Tishelman, C.; Scott, A.; Brzostek, T.; Kinnunen, J.; Schwendimann, R.; Heinen, M.M.; Zikos, D.; Sjetne, I.S.; Smith, H.L.; Kutney-Lee, A.
OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in
Aiken, L.H.; Sermeus, W.; Heede, K. Van den; Sloane, D.M.; Busse, R.; McKee, M.; Bruyneel, L.; Rafferty, A.M.; Griffiths, P.; Moreno-Casbas, M.T.; Tishelman, C.; Scott, A.; Brzostek, T.; Kinnunen, J.; Schwendimann, R.; Heinen, M.M.; Zikos, D.; Sjetne, I.S.; Smith, H.L.; Kutney-Lee, A.
OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in gen
Nadeau, Katie; Pinner, Kerri; Murphy, Katie; Belderson, Kristin M
The primary nursing care model optimizes relationship-based care. Despite using a primary nursing model on a pediatric hematology/oncology inpatient unit, it was hypothesized patients and nurses were dissatisfied with the structure of primary care teams and inconsistency of primary assignments. The purpose of this study was to evaluate patient/family and nurse perceptions of our current care model through assessing gaps in its operationalization and satisfaction. This study used a descriptive cross-sectional design featuring patient/family and nurse surveys. Of the 59 patient/family respondents, 93.2% prefer to have a primary nurse care for them and 85% are satisfied with how often they are assigned a primary care team member. Similarly, 63% of the 57 nurse respondents are satisfied with the current implementation of our primary nursing model and 61% state the model reflects good continuity of care. Yet 80.7% of nurses believe safety would improve for a patient whose nurse works shifts consecutively even if not a primary nurse. Overall, patients, families, and nurses value care continuity and meaningful nurse-patient relationships, which is fundamental to primary nursing.
Ko, Woonhwa; Kiser-Larson, Norma
Oncology nursing is often a source of substantial stress for nurses. Many nurses, particularly novice nurses, have inadequate preparation to care for patients at the end of life and their families. Unless nurses prevent or manage work-related stress by using effective coping strategies, oncology nursing staff will continue to suffer from burnout and compassion fatigue. The purpose of this article is to identify stress levels and stressful factors of nurses working in oncology outpatient units and to explore coping behaviors for work-related stress of oncology staff nurses in outpatient units. A descriptive, cross-sectional design was used to identify stress levels and stressful factors for outpatient oncology nurses, investigate differences in stress levels among nurses' demographic characteristics, and explore coping behaviors of the nurses. Study participants (N = 40) included RNs and licensed practical nurses who completed the Nursing Stress Scale, three open-ended questions, and a demographic questionnaire. The highest sources of stress were workload and patient death and dying. Demographic variables of age and work experience in nursing showed a significant positive relationship to work-related stress scores. The three most frequently used coping behaviors were verbalizing, exercising or relaxing, and taking time for self. Continuing education programs on stress management are highly recommended. Outpatient oncology nurses should be nurtured and supported through tailored interventions at multiple levels to help them find effective coping strategies and develop self-care competencies. Although younger and less experienced nurses had lower mean stress scores than older and more experienced nurses, the continuing education programs and tailored interventions would be helpful for all oncology nursing staff.
Köpke, Sascha; Dehning, Kathrin; Molsen, Nadine; Möhler, Ralph; Kasper, Jürgen; Meyer, Gabriele
Over the last decade, stroke units have been increasingly established in Germany. Within these units, nurses have been identified as having a crucial role in the coordination of multi-professional team activities. However, currently very little data exists to support this fact; therefore, a questionnaire was developed to assess various aspects of the nurses' role within the multi-professional team, including cooperation with other team members (e.g., communication behaviour and acceptance within the multi-professional team), contribution to team and unit organisation, and impact on patient recovery. A total of 55 multi-disciplinary staff members from three separate stroke units completed the questionnaire. Results showed that staff have comparable estimates concerning the nurses' level of interdisciplinary cooperation. As well, nurses and other non-medical staff rate nurses' contribution to unit organisation comparably high while physicians' ratings of nurses' contribution are lower. The professional groups' ratings of the nurses' contribution to patient recovery vary. The results indicate that German stroke unit nurses contribute significantly to stroke unit care by acting as coordinators of the unit organisation for various multi professional team members.
... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1160.104 Section 1160.104 Agriculture... Definitions § 1160.104 United States. United States means the 48 contiguous states in the continental United States and the District of Columbia, except that United States means the 50 states of the United......
Hung, Chang-Chiao; Lee, Bih-O; Tsai, Shu-Ling; Tseng, Yun Shan; Chang, Chia-Hao
Medication errors have long been considered critical in global health care systems. However, few studies have been conducted to explore the effects of nursing unit structure on medication errors. The purpose of this study, therefore, was to determine the effects of structural factors on medication errors in nursing units. A total of 977 staff nurses and 62 head nurses participated in this cross-sectional design study. The findings show that professional autonomy (β = .53, t = 6.03, p nursing experts (β = .52, t = 5.99, p medication error rates. This study shows that the structural factors influence medication administration and the mechanistic approach is specifically in relation of low medication error rates. The author suggests that head nurses should consider strategies that require adjustments to unit control mechanisms.
Dargahi, Hossein; Shaham, Golsa
Healthcare workers suffer from work-related or occupational stress. This can lead to severe distress, burnout or physical illness, and finally to decrease quality of work life and services provision. Nurses must be aware of retential stressors, because they add to the cumulative effect of other stressful events. Holmes and Rahe both found a relationship between life change unit as stressors and health changes. This research reported here aims to measure the life change units as stressors among Iranian Hospitals Nurses by LCU rating. A cross - sectional, descriptive and analytical study was conducted among 389 nurses working in 15 teaching hospitals in Tehran, Iran. The respondents were asked to select each of 54 events that cause stress ranked in order of their life change units developed by Holmes and Rahe as stress scale. Before beginning the main study, the reliability and coincidental validity was performed. All data were analyzed using SPSS for windows version 18, t-test, Anova statistical methods. Approximately, half of the nurses associated major mortgage, foreclosure of mortgage or loan. More than 50% of the Iranian nurses had 150-300 and more than 300 LCU rating which had the chance to expose to extremely serious risk to health.Iranian hospitals nurses suffer from stress that caused by Life Change Units organizational factors such as change in the financial state, change in the work environment and major mortgage. We recommend to Iranian nursing policy-makers to choose strategies to help nurses' cope effectively with workplace stressors. Nursing managers and / or nursing management should develop strategies to address and improve the quality of working conditions for nurses in the hospitals. Providing educational and career prospects can contribute to decrease nurses' occupational stress level, the maintaining their work ability.
Full Text Available Healthcare workers suffer from work-related or occupational stress. This can lead to severe distress, burnout or physical illness, and finally to decrease quality of work life and services provision. Nurses must be aware of retential stressors, because they add to the cumulative effect of other stressful events. Holmes and Rahe both found a relationship between life change unit as stressors and health changes. This research reported here aims to measure the life change units as stressors among Iranian Hospitals Nurses by LCU rating. A cross - sectional, descriptive and analytical study was conducted among 389 nurses working in 15 teaching hospitals in Tehran, Iran. The respondents were asked to select each of 54 events that cause stress ranked in order of their life change units developed by Holmes and Rahe as stress scale. Before beginning the main study, the reliability and coincidental validity was performed. All data were analyzed using SPSS for windows version 18, t-test, Anova statistical methods. Approximately, half of the nurses associated major mortgage, foreclosure of mortgage or loan. More than 50% of the Iranian nurses had 150-300 and more than 300 LCU rating which had the chance to expose to extremely serious risk to health.Iranian hospitals nurses suffer from stress that caused by Life Change Units organizational factors such as change in the financial state, change in the work environment and major mortgage. We recommend to Iranian nursing policy-makers to choose strategies to help nurses cope effectively with workplace stressors. Nursing managers and / or nursing management should develop strategies to address and improve the quality of working conditions for nurses in the hospitals. Providing educational and career prospects can contribute to decrease nurses occupational stress level, the maintaining their work ability.
Dikken, Jeroen; Hoogerduijn, Jita G.; Klaassen, Sharon; Lagerwey, Mary D; Shortridge-Baggett, Lillie; Schuurmans, Marieke J.
Background The Knowledge about Older Patients-Quiz (KOP-Q) is designed as a unidimensional scale measuring knowledge of hospital nurses about older patients. Furthermore, the KOP-Q measures a second unidimensional construct, certainty of hospital nurses about their knowledge. The KOP-Q is developed
Nadolski, Charles; Britt, Pheraby; Ramos, Leah C
The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit's capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics. This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units. The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels. The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.
Travers, Jasmine; Smaldone, Arlene; Cohn, Elizabeth Gross
A health-care workforce representative of our nation's diversity is a health and research priority. Although racial and ethnic minorities represent 37% of Americans, they comprise only 16% of the nursing workforce. The purpose of this study was to examine the effect of state legislation on minority recruitment to nursing. Using data from the National Conference of State Legislatures, American Association of Colleges of Nursing, and U.S. census, we compared minority enrollment in baccalaureate nursing programs of states (Texas, Virginia, Michigan, California, Florida, Connecticut, and Arkansas) before and 3 years after enacting legislation with geographically adjacent states without legislation. Data were analyzed using descriptive and chi-square statistics. Following legislation, Arkansas (13.8%-24.5%), California (3.3%-5.4%), and Michigan (8.0%-10.0%) significantly increased enrollment of Blacks, and Florida (11.8%-15.4%) and Texas (11.2%-13.9%) significantly increased enrollment of Hispanic baccalaureate nursing students. States that tied legislation to funding, encouragement, and reimbursement had larger enrollment gains and greater minority representation. © The Author(s) 2015.
Trepichio,Priscilla Branco; Guirardello,Edinêis de Brito; Duran,Erika Christiane Marocco; de Brito, Ana Paula
Chronic kidney failure (CKF), which is frequently silent, can lead to considerable changes in the lives of patients. Depending on the stage, hospitalization and hours of nursing care are required to ensure medical and surgical treatment. The aim of this descriptive and quantitative study is to measure nursing workload at a nephrology unit based on daily application of the Nursing Activities Score (NAS) for 47 consecutive days. Patients were mostly young male adults in the chronic stage of the...
Galletta, Maura; Portoghese, Igor; Battistelli, Adalgisa; Leiter, Michael P
To report a study of the relationship between variables at the group and individual level with nurses' intention to leave their unit. Workplaces are collective environments where workers constantly interact with each other. The quality of working relationship employees develop at the unit-level influences both employee outcomes and unit performance by shaping employee attitudes. The study was a cross-sectional design with self-administered questionnaires. A questionnaire including measures of leader-member exchange and nurse-physician collaboration analysed at group-level and affective commitment and turnover intention analysed at individual level, was administered individually to 1018 nurses in five Italian hospitals. Data were collected in 2009. A total of 832 nurses (81·7% response rate) completed questionnaires. The results showed that affective commitment at individual level completely mediated the relationship between leader-member exchange at group-level and nursing turnover intention. Furthermore, the cross-level interaction was significant: at individual level, the nurses with high levels of individual affective commitment towards their unit showed low levels of turnover intention and this relationship was stronger when the nurse-physician collaboration at group-level was high. This study showed the importance for organizations to implement management practices that promote both high-quality nurse-supervisor and nurse-physician relationships, because they increase nurses' identification with their units. Individual affective commitment is an important quality for retaining a workforce and good nurses' relationship at group-level relationships with both supervisors and physicians are instrumental in developing identification with the work unit. Thus, the quality of relationship among staff members is an important factor in nurses' decision to leave. © 2012 Blackwell Publishing Ltd.
Background Studies in neuroscience show that effective judgement and decision making require tempered emotion to provide a guiding ‘rudder’ revealing knowing to be a ‘feeling state’(Immordino and Damassio, 2007). Emotional labour as a central feature of nursing practice is well documented (Gray, 2009). Theorists have identified emotions as tools for reflection but this area of knowledge remains underdeveloped (Bradbury- Jones, Hughes, Murphy, Parry and Sutton, 2009). Aims This pap...
Bardenheier, Barbara; Wortley, Pascale; Shefer, Abigail; McCauley, Mary Mason; Gravenstein, Stefan
Objectives Nationwide among nursing home residents, receipt of the influenza vaccine is 8 to 9 percentage points lower among blacks than among whites. The objective of this study was to determine if the national inequity in vaccination is because of the characteristics of facilities and/or residents. Design Cross-sectional study with multilevel modeling. Setting and Participants States in which 1% or more of nursing home residents were black and the difference in influenza vaccination coverage between white and black nursing home residents was 1 percentage point or higher (n = 39 states and the District of Columbia). Data on residents (n = 2,359,321) were obtained from the Centers for Medicare & Medicaid Service’s Minimum Data Set for October 1, 2008, through March 31, 2009. Measurements Residents’ influenza vaccination status (vaccinated, refused vaccine, or not offered vaccination). Results States with higher overall influenza vaccination coverage among nursing home residents had smaller racial inequities. In nursing homes with higher proportions of black residents, vaccination coverage was lower for both blacks and whites. The most dramatic inequities existed between whites in nursing homes with 0% blacks (L1) and blacks in nursing homes with 50% or more blacks (L5) in states with overall racial inequities of 10 percentage points or more. In these states, more black nursing home residents lived in nursing homes with 50% or more blacks (L5); in general, the same homes with low overall coverage. Conclusion Inequities in influenza vaccination coverage among nursing home residents are largely because of low vaccination coverage in nursing homes with a high proportion of black residents. Findings indicate that implementation of culturally appropriate interventions to increase vaccination in facilities with larger proportions of black residents may reduce the racial gap in influenza vaccination as well as increase overall state-level vaccination. PMID:22420974
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Cardoso, Ana Carla Moreira; Figueiredo, Rosely Moralez de
.... This exploratory and descriptive study characterizes the potential risk of biological exposure in procedures performed by nursing professionals in ten Family Health units in São Carlos-SP, Brazil...
Roberta Juliane Tono de Oliveira
Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.
Krugman, Mary E; Sanders, Carolyn L
Nurse managers face significant pressures in the rapidly changing healthcare environment. Staying current with multiple sources of data, including reports that detail institutional and unit performance outcomes, is particularly challenging. A Nurse Manager Customized Profile was developed at a western academic hospital to provide a 1-page visual of pertinent data to help managers and director supervisors focus coaching to improve unit performance. Use of the Decisional Involvement Scale provided new insights into measuring manager performance.
Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.
Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik
To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout
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... United States Mint ACTION: Notification of Pricing for 2010 United States Mint Presidential $1 Coin Proof Set. \\TM\\ SUMMARY: The United States Mint is announcing the price of the 2010 United States Mint Presidential $1 Coin Proof Set. The 2010 United States Mint Presidential $1 Coin Proof Set, featuring $1...
Rapp, Carla Gene; Onega, Lisa L.; Tripp-Reimer, Toni; Mobily, Paula; Wakefield, Bonnie; Kundrat, Mary; Akins, Jackie; Wadle, Karen; Mentes, Jan; Culp, Ken; Meyer, Jean; Waterman, James
Describes the development and evaluation of an eight-hour educational program designed to prepare staff nurses to perform in a new role, the unit-based acute confusion Resource Nurse (ACRN). Tests showed that knowledge and confidence significantly increased for participants as a result of their participation in the educational program. (Author/GCP)
Ayuso-Murillo, D; Colomer-Sánchez, A; Herrera-Peco, I
In this study researchers are trying to analyse the personality factors related to social skills in nurses who work in: Intensive Care Units, ICU, and Hospitalisation units. Both groups are from the Madrid Health Service (SERMAS). The present investigation has been developed as a descriptive transversal study, where personality factors in ICU nurses (n=29) and those from Hospitalisation units (n=40) were compared. The 16PF-5 questionnaire was employed to measure the personality factors associated with communication skills. The comparison of the personality factors associated to social skills, communication, in both groups, show us that nurses from ICU obtain in social receptivity: 5,6 (A+), 5,2 (C-), 6,2 (O+), 5,1 (H-), 5,3 (Q1-), and emotional control: 6,1 (B+), 5,9 (N+). Meanwhile the data doesn't adjust to the expected to emotional and social expressiveness, emotional receptivity and social control, there are not evidence. The personality factors associated to communication skills in ICU nurses are below those of hospitalisation unit nurses. The present results suggest the necessity to develop training actions, focusing on nurses from intensive care units to improve their communication social skills. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.
Happ, Mary Beth; Garrett, Kathryn; Thomas, Dana DiVirgilio; Tate, Judith; George, Elisabeth; Houze, Martin; Radtke, Jill; Sereika, Susan
Background The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured. Objectives To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit. Methods Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication. Results Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards). Conclusions Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials. PMID:21362711
Darmann-Finck, Ingrid; Reuschenbach, Bernd
Competency measurement is central to the optimisation of outcome oriented educational processes in nursing, similar to the concept of evidence based practice. The classification of measurement tools provides the basis for describing the current state of research and development in relation to competence measurement in nursing science, and any gaps are identified. The article concludes with questioning the importance of outcome oriented quality orientation in order to achieve an increase in quality during training. Further methodological developments and qualitative studies are needed to examine the context specific processes of interaction and learning, beyond competence diagnostics. Copyright © 2012. Published by Elsevier GmbH.
Hart, Patricia; Davis, Nancy
This article presents the findings from a study that evaluates the relationships between staffing indicators and patient outcomes at the hospital unit level. Nursing administrators should not only evaluate the impact staffing decisions have on patient outcomes at the hospital level but also examine these relationships at the unit level. The findings from this study have implications for nursing practice in the areas of staff orientation, education, and patient outcome monitoring.
Kang, Kyeong-Hwa; Kim, In-Sook
The purpose of this study was to develop performance measure indicators for hospital nursing units based on a Balanced Scorecard (BSC). This study was a methodological study. The development process consisted of 3 stages. The first stage was setting up strategies for nursing units from a nursing department's mission and vision. The second stage was developing performance measure indicators after a validity check. The third stage was modifying developed performance measure indicators and classifying them. 7 strategies were set up according to 4 perspectives of a BSC. 15 performance measure indicators for hospital nursing units were developed, and the indicators were divided into 8 independent indicators and 7 shared indicators according to the degree of performance responsibility. In addition, they were classified into two groups, 7 leading indicators and lagging indicators. The result of this study suggests that performance measure indicators for hospital nursing units provide a framework and method for nursing organizations' performance management. Also, the developed indicators are expected to provide valuable information for successful organization management.
Soares, Cândida Elizabete Dos Santos; Biagolini, Rosângela Elaine Minéo; Bertolozzi, Maria Rita
The present study aimed to analyze the perceptions and expectations regarding nursing duties of nursing assistants (NA) working in basic health units (BHUs) in a region of the municipality of São Paulo. This qualitative study used the collective subject discourse (CSD) technique. It took place in three BHUs with 20 NAs. Data were collected from interviews conducted in 2007. The NAs interviewed associated nursing duties with personal attitudes in daily work, seeing the nurse as a direct care provider who has the role of advisor and coordinator and who performs an excessive number of duties. The expectations of the interviewees were the participation of nurses in providing direct care to the user and the power to coordinate the team and assess the users' needs. Understanding nursing duties is important to respond appropriately to the needs of the community.
In summary, irrigation costs and prices are rising in most regions of the United States, due to a combination of increasing scarcity, changes in public preferences regarding water allocation among competing uses, increasing budget scrutiny in the national and state legislatures, rising energy prices, and increasing awareness of climate change and the potential implications for rainfall and the availability of surface water resources. These issues likely will continue encouraging public offici...
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1250.308 Section 1250.308 Agriculture... Research and Promotion Order Definitions § 1250.308 United States. United States means the 48 contiguous States of the United States of America and the District of Columbia....
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 592.311 Section 592... § 592.311 United States. The term United States, when used in the geographic sense, means the several States, the District of Columbia, and any commonwealth, territory, or possession of the United States....
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.23 Section 1205.23 Agriculture... Procedures for Conduct of Sign-up Period Definitions § 1205.23 United States. The term United States means the 50 states of the United States of America. Procedures...
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.313 Section 1205.313 Agriculture... Research and Promotion Order Definitions § 1205.313 United States. United States means the 50 States of the United States of America....
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false United States. 120.13 Section 120.13 Foreign... United States. United States, when used in the geographical sense, includes the several states, the Commonwealth of Puerto Rico, the insular possessions of the United States, the District of Columbia,...
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1219.26 Section 1219.26 Agriculture..., AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.26 United States. United States means collectively the several 50 States of the United States, the District...
... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1150.106 Section 1150.106 Agriculture... Order Definitions § 1150.106 United States. United States means the 48 contiguous States in the continental United States....
As might be expected,educational institutions in the United States reflect the nation's basic values,especially the ideal of equality of opportunity.From elementary school through college,Americans believe that everyone deserves an equal opportunity to get a good education.
United States Navy DL Perspective CAPT Hank Reeves Navy eLearning Project Director 10 August 2010 Report Documentation Page Form ApprovedOMB No...Marine Corps (USMC) Navy eLearning Ongoing Shared with USMC, Coast Guard 9 NeL Help Site https://ile-help.nko.navy.mil/ile/ https://s-ile
Dr. Aron Hall, a CDC epidemiologist specializing in norovirus, discusses the impact of norovirus in the United States. Created: 9/9/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Date Released: 9/17/2013.
Anna Newton, Surveillance Epidemiologist at CDC, discusses cholera that was brought to the United States during an outbreak in Haiti and the Dominican Republic (Hispaniola). Created: 11/8/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Date Released: 11/8/2011.
Silvia Helena Henriques Camelo
Full Text Available Objective. The aim in this study was to identify how Intensive Care Unit nurses perceive professional competences in thecare team. Methodology. Qualitative multiple case study with an exploratory focus. The sample consisted of 24 nurses from Intensive Care Units (ICU at two large hospitals. To collect the information, direct observation and - structured, non-structuredand participant - interviews were used. Results. Ninety-six percent of the participants were women, 79% were less than 40 years old, and 63% possessed less than five years of professional experience in ICU. Data analysis revealed three study categories: teamwork as a nursing management tool, improving teamwork, and interpersonal communication for teamwork. Conclusion. At the ICU where the nurses work, a teamwork strategy is observed, which demands cooperation and participation by other disciplines.
... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1209.21 Section 1209.21... Definitions § 1209.21 State and United States. (a) State means any of the several States, the District of Columbia, and the Commonwealth of Puerto Rico. (b) United States means collectively the several States...
As a completely new management concept, organizational culture played a role of guiding, restraining, cohesiving, radianting and encouraging in nursing accreditation .In this paper, the concept of organizational culture of professional accreditation was introduced and the present status of nursing accreditation organizational culture in the United States and the United Kingdom was reviewed,which elicited some useful implications and suggestions for the construction and development of organizational culture of nursing accreditation in China.%组织文化作为一种全新的管理理念,对于护理学专业认证的发展起着导向、约束、凝聚与辐射以及激励作用.文章引入专业认证组织文化的概念,并介绍美、英两国护理学专业认证组织文化的现状,以期为我国护理学专业认证组织文化的形成和发展提供借鉴和启示.
Karanikola, Maria N K; Albarran, John W; Drigo, Elio; Giannakopoulou, Margarita; Kalafati, Maria; Mpouzika, Meropi; Tsiaousis, George Z; Papathanassoglou, Elizabeth D E
To explore the level of moral distress and potential associations between moral distress indices and (1) nurse-physician collaboration, (2) autonomy, (3) professional satisfaction, (4) intention to resign, and (5) workload among Italian intensive care unit nurses. Poor nurse-physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions. A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses. The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0-84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0-84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0-336). The severity of moral distress was associated with (1) nurse-physician collaboration and dissatisfaction on care decisions (r = -0.215, P managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession. © 2013 John Wiley & Sons Ltd.
... United States Mint ACTION: Notification of Citizens Coinage Advisory Committee May 25, 2010 Public Meeting. SUMMARY: Pursuant to United States Code, Title 31, section 5135(b)(8)(C), the United States Mint...: May 25, 2010. Time: 9 a.m. to 12 p.m. Location: 8th Floor Board Room, United States Mint, 801...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 560.307 Section 560.307 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 560.307 United States. The term United States means the United States, including its territories...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 547.310 Section 547.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 547.310 United States. The term United States means the United States,...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 548.310 Section 548.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 586.318 Section 586...) KOSOVO SANCTIONS REGULATIONS General Definitions § 586.318 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or...
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1212.31 Section 1212.31 Agriculture..., Consumer Education, and Industry Information Order Definitions § 1212.31 United States. “United States... territories and possessions of the United States....
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 543.310 Section 543.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 543.310 United States. The term United States means the United States, its territories...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 546.310 Section 546.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...
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... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 594.313 Section 594.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 594.313 United States. The term United States means the United States, its territories...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 588.310 Section 588.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 588.310 United States. The term United States means the United States, its territories...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 593.311 Section 593.311 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 593.311 United States. The term United States means the United States,...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 537.318 Section 537.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....318 United States. The term United States means the United States, its territories and...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 575.319 Section 575.319 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....319 United States. The term United States means the United States, its territories and...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 595.314 Section 595.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 595.314 United States. The term United States means the United States, its territories and...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 596.312 Section 596.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 596.312 United States. The term United States means the United States, including...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 587.310 Section 587...) MILOSEVIC SANCTIONS REGULATIONS General Definitions § 587.310 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 542.310 Section 542.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 540.313 Section 540.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 540.313 United States. The term United States means the United States,...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 597.318 Section 597.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 597.318 United States. The term United States means the United States,...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 544.310 Section 544.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 544.310 United States. The term United States means the United States,...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 545.313 Section 545.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 545.313 United States. The term United States means the United States, its territories...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 585.316 Section 585.316 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 585.316 United States. The term United States means the United States,...
... 7 Agriculture 3 2010-01-01 2010-01-01 false United States. 65.255 Section 65.255 Agriculture..., PEANUTS, AND GINSENG General Provisions Definitions § 65.255 United States. United States means the 50... United States....
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 536.315 Section 536.315 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 536.315 United States. The term United States means the United States, its territories...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 541.310 Section 541.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 541.310 United States. The term United States means the United States, its territories and...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 598.317 Section 598.317 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 598.317 United States. The term United States means the United States, its territories...
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 551.309 Section 551.309 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....309 United States. The term United States means the United States, its territories and...
Using data from the nationally representative National Health and Social Life Survey, this study queried the correlates of masturbation in the United States in 1992. Among those aged 18-60, 38% (CI, 35-41) of women and 61% (CI, 57-65) of men reported any masturbation over the preceding year. The system of factors underlying masturbation was similar for both genders, consistent with a convergence in gender patterns of sexual expression in the United States. Among both women and men, masturbation responded to a stable sexualized personality pattern, catalyzed by early-life factors and manifested in current sexual traits. Strikingly, the masturbation-partnered sex linkage, often conceptualized either as compensating for unsatisfying sex or complementing a satisfactory sex life, appeared to be bimodal for both genders. For some, masturbation complemented an active and pleasurable sex life, while among others, it compensated for a lack of partnered sex or satisfaction in sex.
... outside of the `reaches of the public interest'''); see generally United States v. SBC Commc'ns, Inc., 489... judicial power.'' SBC ] Commc'ns, 489 F. Supp. 2d at 14-15 (citing Microsoft, 56 F.3d at 1462). With... effect of proposed remedies. See, e.g., KeySpan, 763 F. Supp. 2d at 642; SBC Commc'ns, 489 F. Supp. 2d...
President of the United States is the chief executive officer of the federal government, the leader of the executive branch1, and the corn man der-in-chief of the armed forces2. The president has the power to make treaties with other nations, with the advice and consent of two-thirds of the Senate3. The president also appoints4, with Senate's consent, diplomatic representatives ,Supreme Court judges5, and many other officials.
This book presents OECD assessments and recommendations regarding the United States' effort to manage its environment including air, water nature, and biodiversity to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 40 figs., 21 tabs.
Wu, Ning; Mor, Vincent; Roy, Jason
Nursing home quality measures impact policy decisions such as reimbursement or consumer choice. Quality indicators in the United States are collected through the federally mandated Minimum Data Set (MDS). Bias in MDS data collection or coding can thus have a negative impact on policy applications. To understand whether bias was present in coding, the authors studied 5174 pairs of MDS assessments that were independently collected by nursing home staff and study nurses from 206 nursing homes. The authors developed multivariate multilevel models to identify nursing home and resident characteristics that were significantly associated with the data quality of multiple MDS measures of nursing home quality. The outcomes were coding differences between nursing home staff and study nurses. Resident characteristics explained little of the variation in coding differences among facilities, while facilities characteristics explained 4% to 20% of the variation and state location further explained 13% to 34% of the variation. A generalized effect of nursing home state location tended to be consistent across measures. States that overidentified problems also tended to have worse quality indicators and vice versa. Comparisons of MDS-based quality indicators reflect differences in assessment practices at least as much as true quality differences. Efforts to standardize assessment practices across states are needed.
Moghaddasian, Sima; Lak Dizaji, Sima; Mahmoudi, Mokhtar
The patients' families in intensive care units (ICUs) experience excessive stress which may disrupt their performance in daily life. Empathy is basic to the nursing role and has been found to be associated with improved patient outcomes and greater satisfaction with care in patient and his/her family. However, few studies have investigated the nursing empathy with ICU patients. This study aimed to assess nursing empathy and its relationship with the needs, from the perspective of families of patients in ICU. In this cross-sectional study, 418 subjects were selected among families of patients admitted to ICUs in Tabriz, Iran, by convenience sampling, from May to August 2012. Data were collected through Barrett-Lennard Relationship inventory (BLRI) empathy scale and Critical Care Family Needs Intervention (CCFNI) inventories and were analyzed using descriptive and inferential statistical tests. Findings showed that most of the nurses had high level of empathy to the patients (38.8%). There was also statistically significant relationship between nurses' empathy and needs of patients' families (p < 0.001). In this study we found that by increasing the nurse's empathy skills, we would be able to improve providing family needs. Through empathic communication, nurses can encourage family members to participate in planning for the care of their patients. However, further studies are necessary to confirm the results.
Full Text Available In this article a phenomenological qualitative research study is discussed. More attention will be given to the methodology of the research. The objectives of the study are two-fold: firstly to explore and describe the experience of registered nurses nursing in the adult intensive care unit (this is the first phase of the research and to describe guidelines based on the information obtained in the first phase to support the nurses in the form of a support programme in the second phase. The units of research are the registered nurses in the intensive care unit. The characteristics of the unit of research led to the emergence of a qualitative phenomenological research design of an explorative, descriptive and contextual nature. In the discussion of research methodology attention will be given to phase one: data gathering (ethical considerations and informed consent; purposive selection, phenomenological interviews and field notes; data analysis (Tesch’s method of data analysis, methods to ensure trustworthiness, organisation of raw data and integration of findings supported by literature. Five themes were identified through the data analysis: impaired communication with management; discrimination: white on black racism; lack of fair, competitive remuneration and disregard for professional worth; non-conducive physical environment, and stressful working environment. Phase two: Guidelines were described to support the registered nurses in the intensive care unit based on the information obtained in phase one of the research.
Aline Carniato Dalle Nogario
Full Text Available OBJECTIVEUnderstanding nursing actions in the practice of inpatient advocacy in a burn unit.METHODA single and descriptive case study, carried out with nurses working in a referral burn center in southern Brazil. Data were collected through focus group technique, between February and March 2014, in three meetings. Data was analysed through discursive textual analysis.RESULTSThree emerging categories were identified, namely: (1 instructing the patient; (2 protecting the patient; and (3 ensuring the quality of care.CONCLUSIONSThis study identified that the nurses investigated exercised patient advocacy and that the recognition of their actions is an advance for the profession, contributing to the autonomy of nurses and the effectiveness of patients' rights and social justice.
... HIV/AIDS HIV Testing in the United States HIV Testing in the United States Jun 23, 2017 ... States or for refugees. 27 Insurance Coverage of HIV Testing HIV testing that is “medically necessary” – recommended ...
The southwestern United States pined for water in late March and early April 2007. This image is based on data collected by the Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite from March 22 through April 6, 2007, and it shows the Normalized Difference Vegetation Index, or NDVI, for the period. In this NDVI color scale, green indicates areas of healthier-than-usual vegetation, and only small patches of green appear in this image, near the California-Nevada border and in Utah. Larger areas of below-normal vegetation are more common, especially throughout California. Pale yellow indicates areas with generally average vegetation. Gray areas appear where no data were available, likely due to persistent clouds or snow cover. According to the April 10, 2007, update from the U.S. Drought Monitor, most of the southwestern United Sates, including Utah, Nevada, California, and Arizona, experienced moderate to extreme drought. The hardest hit areas were southeastern California and southwestern Arizona. Writing for the Drought Monitor, David Miskus of the Joint Agricultural Weather Facility reported that March 2007 had been unusually dry for the southwestern United States. While California's and Utah's reservoir storage was only slightly below normal, reservoir storage was well below normal for New Mexico and Arizona. In early April, an international research team published an online paper in Science noting that droughts could become more common for the southwestern United States and northern Mexico, as these areas were already showing signs of drying. Relying on the same computer models used in the Intergovernmental Panel on Climate Change (IPCC) report released in early 2007, the researchers who published in Science concluded that global warming could make droughts more common, not just in the American Southwest, but also in semiarid regions of southern Europe, Mediterranean northern Africa, and the Middle East.
Martínez Lara, Concepción; Praena Fernández, Juan Manuel; Gil García, Eugenia
Clinical Management Unit (CMU) is currently set in the Andalusian health institutions as the model reference management. This management model aims to make all healthcare professionals a powerful idea: the best performance of health resources is performed to drive clinical practice using the least number of diagnostic and therapeutic resources. The CMU not only aims at saving money, in the Clinical Management Agreement  are measured all the dimensions that make up the UGC: research, training, clinical process, the portfolio of services, objectives, financial management and indicators to control and security. The CMU is to transfer more responsibilities to Health Care Professionals, involving them in the management of the Unit. The CMU sets new approaches that directly affect health professionals and presents advantages and disadvantages for the Doctors and the Nurses, involved in achieving excellence in care work. Nurse Practitioners shows expectant before the changes are generated in health institutions and appears a discussion of skills derived from the CMU. Some Nurses believe that the bur, den of care to which they are subjected in public institutions has increased since the onset of the CMU and yet others believe that they are motivated and rewarded for the results obtained with this model of management. In health institutions, some professionals are more motivated than others and this is found in the outcome of health care activity . Given the positive and negative perceptions that arise in the CMU Professional Nurses, it is considered appropriate to focus the objective of this work in the search for factors that influence job satisfaction of nurses in the CMU. There are few studies about the CMU  but are absent when linked with nursing, so the pursuit of scientific knowledge related to nursing management model based on Clinical and Quality Care can lead to establish new concepts around the nursing profession, a profession in which major changes are
Aragon, Stephen J; Richardson, Liana J; Lawrence, Wanda; Gesell, Sabina B
Objective. This study examined to what degree patient-centeredness-measured as an underlying ability of obstetrical nurses-influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units.
Vinicia de Holanda Cabral
Full Text Available To identify the main nursing diagnostic titles used in the care of critically ill patients hospitalized in an Intensive Care Unit, verifying the presence thereof in the diagnoses of NANDA International’s Taxonomy II. Methods: descriptive and documental study, in which 69 medical records of patients aged over 18 years were consulted. Results: 22 nursing diagnostic titles were found; the most frequent was risk for infection (99.0%, risk for skin integrity (75.0% and risk for aspiration (61.0%. Most diagnoses were in the domains safety/ protection (43.0% and activity/rest (26.5%. Conclusions: authors identified the main nursing diagnostic titles used in the care of critically ill patients admitted to the Intensive Care Unit and the presence thereof in the diagnoses of NANDA International’s Taxonomy II.
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1206.23 Section 1206.23 Agriculture... INFORMATION Mango Promotion, Research, and Information Order Definitions § 1206.23 United States. United... Rico, and the territories and possessions of the United States....
Darbon, Rémy; Dalphin, Catherine; Prieto, Nathalie; Cheucle, Éric
The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1280.127 Section 1280.127 Agriculture... INFORMATION ORDER Lamb Promotion, Research, and Information Order Definitions § 1280.127 United States. United States means collectively the 50 States and the District of Columbia....
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1218.22 Section 1218.22 Agriculture... INFORMATION ORDER Blueberry Promotion, Research, and Information Order Definitions § 1218.22 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto...
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1215.20 Section 1215.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... United States. United States means all of the States. Popcorn Board...
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1260.108 Section 1260.108 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Promotion and Research Order Definitions § 1260.108 United States. United States means the 50 States and...
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1216.30 Section 1216.30 Agriculture... INFORMATION ORDER Peanut Promotion, Research, and Information Order Definitions § 1216.30 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto...
... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1221.32 Section 1221.32 Agriculture... INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.32 United States. United States or U.S. means collectively the 50 States, the District of Columbia, the Commonwealth...
Trepichio, Priscilla Branco; Guirardello, Edinêis de Brito; Duran, Erika Christiane Marocco; de Brito, Ana Paula
Chronic kidney failure (CKF), which is frequently silent, can lead to considerable changes in the lives of patients. Depending on the stage, hospitalization and hours of nursing care are required to ensure medical and surgical treatment. The aim of this descriptive and quantitative study is to measure nursing workload at a nephrology unit based on daily application of the Nursing Activities Score (NAS) for 47 consecutive days. Patients were mostly young male adults in the chronic stage of the disease or admitted for kidney transplant. A total of 833 observations were obtained from 62 patients. The resulting NAS workload upon admission was 52%, corresponding to 12.5 hours of care per patient for 24 hours, which is similar to the workload found in intensive care units. This profile allows calculation of nursing work hours required for each patient and is a valuable tool for nursing managers when determining the number of staff members required to ensure assistance. Other studies should be conducted for clinical validation.
Grabowski, David C.; Aschbrenner, Kelly A.; Feng, Zhanlian; Mor, Vincent
The institutionalization of individuals with mental illness in nursing homes is an important policy concern. Using nursing home Minimum Data Set assessments from 2005, we found large cross-state variation in both the rates of mental illness among nursing home admissions and the estimated rates of nursing home admissions among persons with mental illness. We also found that newly admitted individuals with mental illness were younger and more likely to become long-stay residents. Taken together...
Suguna, Anbazhagan; Joseph, Bobby
Occupational violence among health care professionals is a cause for concern, although often neglected especially in developing countries like India. Violence undermines the healing mission of the health care organization and interferes with the ability of the health care team to optimally contribute to positive patient outcomes. The authors discuss a case of a human bite of a staff nurse on a psychiatric unit in a tertiary care Indian hospital. The reported violence against this staff nurse lead to her admission for emergency care followed by emotional stress. Issues related to prevention of occupational violence are also discussed. © 2015 The Author(s).
Wlody, Ginger Schafer
This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.
Gregg, Misuzu F; Wakisaka, Toyomi; Hayashi, Chifuyu
The purpose of this study was to explore the strategies used by nurse managers in Japan to facilitate the integration of newly graduate nurses (NGNs) into their clinical units. The integration of NGNs into clinical units is an important issue for both NGNs and nurse managers because the first year of practice plays a vital role in a NGN's career. Data were generated through semi-structured interviews with 9 nurse managers in 9 acute care hospitals. Data analysis was conducted using a qualitative content analysis method. Nurse managers used a total of 6 strategies: understanding the circumstances of NGNs, providing opportunities for experience and learning, supporting nurses who teach NGNs, facilitating self-learning, promoting awareness of being a nurse in the clinical unit, and strengthening the sense of comradeship in clinical units. Three of these strategies were particularly important for NGNs' integration into clinical units: facilitating self-learning, promoting awareness of being a nurse in the clinical unit, and strengthening the sense of comradeship in clinical units. These strategies were described in this study. The strategies adopted by nurse managers should be aimed at all nurses, not just NGNs, in order to strengthen the sense of comradeship in clinical units. This approach would create a supportive environment for the integration of NGNs into clinical units. The strategies presented in this study can be utilized not just by nurse managers but all senior nurses in the unit. NGNs can use these strategies to help them understand what they need to do to become a full member of their unit.
Sowan, Azizeh K; Vera, Ana G; Fonseca, Elma I; Reed, Charles C; Tarriela, Albert F; Berndt, Andrea E
Studies on nurse competence on alarm management are a few and tend to be focused on limited skills. In response to Phase II of implementing the National Patient Safety Goal on clinical alarm systems safety, this study assessed nurses' perceived competence on physiologic monitors use in intensive care units (ICUs) and developed and validated a tool for this purpose. This descriptive study took place in a Magnet hospital in a Southwestern state of the U.S. A Nurse Competence on Philips Physiologic Monitors Use Survey was created and went through validation by 13 expert ICU nurses. The survey included 5 subscales with 59 rated items and two open-ended questions. Items on the first 4 subscales reflect most common tasks nurses perform using physiologic monitors. Items on the fifth subscale (advanced functions) reflect rarely used skills and were included to understand the scope of utilizing advanced physiologic monitors' features. Thirty nurses from 4 adult ICUs were invited to respond to the survey. Thirty nurses (100%) responded to the survey. The majority of nurses were from Neuro (47%) and Surgical Trauma (37%) ICUs. The data supported the high reliability and construct validity of the survey. At least one (3%) to 8 nurses (27%) reported lack of confidence on each item on the survey. On the first four subscales, 3% - 40% of the nurses reported they had never heard of or used 27 features/functions on the monitors. No relationships were found between subscales' scores and demographic characteristics (p > .05). Nurses asked for training on navigating the central-station monitor and troubleshooting alarms, and the use of unit-specific super users to tailor training to users' needs. This is the first study to create and test a list of competencies for physiologic monitors use. Rigorous, periodic and individualized training is essential for safe and appropriate use of physiologic monitors and to decrease alarm fatigue. Training should be comprehensive to include all
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Illustrates how Mexico and the United States represent two versions of Western civilization that are profoundly different from one another. Concludes that the United States has always ignored minorities in foreign and domestic policy. Suggests that, to conquer its enemies, the United States must first conquer its historical attitude toward…
Staggs, Vincent S; Dunton, Nancy
Nursing turnover is expensive and may have adverse effects on patient care. Little is known about turnover's association with most hospital and nursing unit characteristics, including nurse staffing level and registered nurse skill mix. To explore associations between nursing unit turnover rates and several hospital- and unit-level variables, including staffing level and skill mix. Observational cross-sectional study of longitudinal data. 1884 nursing units in 306 U.S. acute care hospitals. During a 2-year period units reported monthly data on staffing and turnover. Total nursing staff turnover and registered nurse turnover rates were modeled as dependent variables in hierarchical Poisson regression models. The following hospital characteristics were considered as predictors: Magnet(®) status, ownership (government or non-government), teaching status, locale (metropolitan, micropolitan, or rural), and size (average daily census). The U.S. state in which the hospital was located was included as a covariate. Unit-level variables included total nursing hours per patient day, size of nursing staff, registered nurse skill mix, population age group (neonatal, pediatric, or adult), and service line (critical care, step-down, medical, surgical, medical/surgical, psychiatric, or rehabilitation). Government ownership, Magnet designation, and higher skill mix were associated with lower total turnover and registered nurse turnover. Neonatal units had lower total and registered nurse turnover than pediatric units, which had lower total and registered nurse turnover than adult units. Unit service line was associated only with total turnover. Psychiatric, critical care, and rehabilitation units had the lowest mean turnover rates, but most differences between service lines were not significant. The other explanatory variables considered were not significant. Several hospital and unit characteristic variables have significant associations with nursing turnover; these associations
Full Text Available Context: The total time spent in nursing care depends on the type of patient and the patient′s condition. We analysed factors that influenced the time spent in nursing a patient. Aims : To analyse the factors in a patient′s condition that influenced time spent in nursing a patient. Materials and Methods: This study was performed in the Surgical Intensive Care Unit of a tertiary referral centre, over a period of one month. The total time spent on a patient in nursing care for the first 24 hours of admission, was recorded. This time was divided into time for routine nursing care, time for interventions, time for monitoring and time for administering medications. Statistical analysis used: A backward stepwise linear regression analysis using the age, sex, diagnosis, type of admission and ventilatory status as variables, was done. Results: Patients admitted after elective surgery required less time (852.4 ± 234.1 minutes, than those admitted after either emergency surgery (1069.5 ± 187.3 minutes, or directly from the ward or the emergency room (1253.7 ± 42.1 minutes. Patients who were ventilated required more time (1111.5 ± 132.5 minutes, than those brought on a T-piece (732.2 ± 134.8 minutes or extubated (639.5 ± 155.6 minutes. The regression analysis showed that only the type of admission and the ventilatory status significantly affected the time. Conclusions : This study showed that the type of admission and ventilatory status significantly influenced the time spent in nursing care. This will help optimal utilization of nursing resources.
Full Text Available Introduction: The patients’ families in intensive care units (ICUs experience excessive stress which may disrupt their performance in daily life. Empathy is basic to the nursing role and has been found to be associated with improved patient outcomes and greater satisfaction with care in patient and his/her family. However, few studies have investigated the nursing empathy with ICU patients. This study aimed to assess nursing empathy and its relationship with the needs, from the perspective of families of patients in ICU.Methods: In this cross-sectional study, 418 subjects were selected among families of patients admitted to ICUs in Tabriz, Iran, by convenience sampling, from May to August 2012. Data were collected through Barrett-Lennard Relationship inventory (BLRI empathy scale and Critical Care Family Needs Intervention (CCFNI inventories and were analyzed using descriptive and inferential statistical tests. Results: Findings showed that most of the nurses had high level of empathy to the patients (38.8%. There was also statistically significant relationship between nurses’ empathy and needs of patients’ families (p < 0.001. Conclusion: In this study we found that by increasing the nurse’s empathy skills, we would be able to improve providing family needs. Through empathic communication, nurses can encourage family members to participate in planning for the care of their patients. However, further studies are necessary to confirm the results.
Mace, Kimberly E; Arguin, Paul M
Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. This report summarizes cases in persons with onset of illness in 2014 and trends during previous years. Malaria cases diagnosed by blood film, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System, National Notifiable Diseases Surveillance System, or direct CDC consultations. CDC conducts antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. Data from these reporting systems serve as the basis for this report. CDC received reports of 1,724 confirmed malaria cases, including one congenital case and two cryptic cases, with onset of symptoms in 2014 among persons in the United States. The number of confirmed cases in 2014 is consistent with the number of confirmed cases reported in 2013 (n = 1,741; this number has been updated from a previous publication to account for delayed reporting for persons with symptom onset occurring in late 2013). Plasmodium falciparum, P. vivax, P. ovale, and P. malariae were identified in 66.1%, 13.3%, 5.2%, and 2.7% of cases, respectively
Aragon, Stephen J.; Richardson, Liana J.; Lawrence, Wanda; Gesell, Sabina B.
Objective. This study examined to what degree patient-centeredness—measured as an underlying ability of obstetrical nurses—influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units. PMID:24027634
Full Text Available Valerie Wilson,1,2 Sheree Paterson,3 Kelly Kornman1 1Nursing Research and Practice Development Unit, The Children’s Hospital at Westmead, Westmead, NSW, Australia; 2Faculty of Nursing Midwifery Health, The University of Technology, Sydney, Broadway, NSW, Australia; 3Formerly of the Nursing Research and Practice Development Unit, The Children’s Hospital at Westmead, Westmead, NSW, Australia Purpose: The aim of the leadership development program was to enhance participants’ understanding of person-centered leadership in the context of their nursing unit manager (NUM roles. Materials and methods: This article details the results of the NUM leadership development program (LDP. Twenty-one NUMs from an Australian pediatric hospital participated in the 8-month program. The evaluation encompassed a group claims/concerns/issues session, one-on-one interviews, and written feedback. Data were themed using a four-step sequential process. Results: The NUM LDP had a positive impact on the leadership practices of the participants. Six key themes were identified from the evaluation: “forming the group”; “being in the group”; “translating into practice”; “how we see ourselves; how do we want to be seen?”; “positive outcomes for me”; and “positive outcomes for others”. Conclusion: This study showed improvements in the leadership understanding and practice of NUMs who participated in the program. Further research, particularly into the transferability of skills and active participatory aspects of these types of evaluation studies, is required. Keywords: nurse, evaluation, person-centered care, experiential learning
Carmen Lúcia Mottin Duro
Full Text Available This study aimed to assess nurses’ perception regarding the risk classification in emergency care units. It is a descriptive study that used a qualitative approach and that was conducted with 55 nurses from emergency care units in the south of Brazil. Data were collected between July and October, 2011, through open questions, answered in writing. The data collected were submitted to the thematic analysis technique. Results indicate that the risk classification contributes to the organization of the service flow provided to patients, intervening in severe cases and preventing sequelae. Difficulties were described, such as: inadequate physical installations, overcrowding, disagreement in the definition of priorities among doctors and nurses and lack of articulation between the emergency care network and basic health care. It is highlighted the need to improve the physical structure, the quantity of human resources and the implementation of public policies to overcome these challenges.
Introduction Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses’ competences. This study aimed to explain nurses’ competence in the ICCU. Methods This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012–2013. Interviews were recorded, tran...
Bay, Jennifer M.; Bledsoe, Ann M.; Reys, Robert E.
Presents activities on estimation, scaling, area of nonstandard shapes, algebraic thinking, and real-life situations using the United States of America. These activities make it possible to integrate mathematics and social studies. Uses technology by employing geometry software packages such as The Geometer's Sketchpad, Cabri, and Geometric…
Toode, K; Routasalo, P; Helminen, M; Suominen, T
This study looks to describe the relationships between hospital nurses' individual priorities, internal psychological states and their work motivation. Connections between hospital nurses' work-related needs, values and work motivation are essential for providing safe and high quality health care. However, there is insufficient empirical knowledge concerning these connections for the practice development. A cross-sectional empirical research study was undertaken. A total of 201 registered nurses from all types of Estonian hospitals filled out an electronic self-reported questionnaire. Descriptive statistics, Mann-Whitney, Kruskal-Wallis and Spearman's correlation were used for data analysis. In individual priorities, higher order needs strength were negatively correlated with age and duration of service. Regarding nurses' internal psychological states, central hospital nurses had less sense of meaningfulness of work. Nurses' individual priorities (i.e. their higher order needs strength and shared values with the organization) correlated with their work motivation. Their internal psychological states (i.e. their experienced meaningfulness of work, experienced responsibility for work outcomes and their knowledge of results) correlated with intrinsic work motivation. Nurses who prioritize their higher order needs are more motivated to work. The more their own values are compatible with those of the organization, the more intrinsically motivated they are likely to be. Nurses' individual achievements, autonomy and training are key factors which influence their motivation to work. The small sample size and low response rate of the study limit the direct transferability of the findings to the wider nurse population, so further research is needed. This study highlights the need and importance to support nurses' professional development and self-determination, in order to develop and retain motivated nurses. It also indicates a need to value both nurses and nursing in
Paliadelis, Penny S
Nursing unit managers (NUMs) occupy the often unenviable position of first-line management in many health services in Australia. As such, their role is complex and multifaceted requiring an intertwining of their clinical and managerial responsibilities. While there is an abundance of studies that explore and describe the various management roles in many professions and industries, little is known about the experiences of nurses as managers, particularly in rural settings. This article focuses on the education and support needs of rural nursing unit managers. A qualitative study design was used to explore the stories of a number of nursing unit managers in rural New South Wales, Australia. Data was collected using semi-structured individual interviews. Data was analysed using a voice-relational method as a framework for more clearly hearing the voices of participants. This method of data analysis is particularly useful for hearing from those who do not usually have a 'strong' voice, for gaining an understanding of the context of the interviews, and for acknowledging the role of the researcher in the research process. All NUMs employed in a single regional health authority in rural Australia were invited to participate. Out of 42 NUMs in the region, 20 agreed to be interviewed. Nursing unit managers were asked to reflect on their experiences prior to and during the early days within the position. In summary, all the NUMs: believed they were promoted because of their clinical expertise; felt unprepared for the managerial and administrative aspects of their role; continued to identify as nurses rather than as managers; found the role isolated them from their former peer group. Those employed in small facilities had limited opportunities for education and peer support. Based on the NUMs' experiences and suggestions, the following information would have helped them to cope with the demands of their new role: information and discussions about the role expectations of
Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1927) represents the State Plane Coordinate System (SPCS) Zones for the 1927 North American Datum within United States.
Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1983) represents the State Plane Coordinate System (SPCS) Zones for the 1983 North American Datum within United States.
... Order from the National Technical Information Service NCHS Death in the United States, 2011 Recommend on Facebook ... 2011 SOURCE: National Vital Statistics System, Mortality. Do death rates vary by state? States experience different mortality ...
Resnick, Phillip J
In the United States the Accreditation Council of Graduate Medical Education determines the curriculum required for fellows in forensic psychiatry to become board certified as a subspecialist. Areas that must be covered during the one year fellowship include criminal issues, such as insanity; civil issues, such as tort law and Workers' Compensation; legal regulation of psychiatry, such as confidentiality and involuntary hospitalization; and correctional psychiatry issues, such as dual agency and prisoner's rights. Fellows are also expected to have knowledge about juvenile courts, the structure of the legal system, and child custody issues. In addition, fellows are required to analyze complex cases and write forensic reports which are well reasoned. Teaching methods include lectures, storytelling, use of video vignettes, and mock trials. Additional teaching methodologies include group supervision of fellows in their report writing and direct observation of giving testimony. During the year we see fellows evolve and shift their orientation from being an advocate for patients to perceiving their role as serving justice.
Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie
There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.
targets for worldwide reduction or elimination of the cultiva- tion, production, and commercial-scale import of cocaine, opium, heroin, mari- juana ...international sanctions against state sponsors of terrorism and urges their strict enforcement. State presses state spon- sors to abandon their support for
Sammer, Christine Elizabeth; James, Barbara R
Discussions about a culture of patient safety abound, yet nurse leaders continue to struggle to achieve such a culture in today's complex and fast-paced healthcare environment. In this article the authors discuss the concept of a patient safety culture, present a fictional scenario describing what happened in a hospital that lacked a culture of patient safety, and explain what should have happened in the above scenario. This discussion is offered within a framework consisting of seven driving factors of patient safety. These factors include leadership, evidence-based practice, teamwork, communication, and a learning, just, and patient-centered culture. Throughout, an emphasis is placed on leadership at the unit level. Nurse managers will find practical examples illustrating how leaders can help their teams establish a culture that offers the patient quality care in a safe environment.
Full Text Available The era of optimism which prevailed in the United States since the Korean War, came to an abrupt end after the debacle in Vietnam. By the end of the Seventies the United States was no longer the dominant military power. American foreign policy lacked consistence, coherence and a strategic sense. The United States became indecisive. Under these circumstances the Soviet Union successfully enforced its imperialistic designs upon countries far from its shores.
Tekindal, Benian; Tekindal, Mustafa Agah; Pinar, Gul; Ozturk, Filiz; Alan, Sumeyra
One of the biggest problems of work life today is burnout. With burnout, satisfaction of clients and service givers reduces. In this study, burnout levels of nurses working in the internal, surgical and intensive care units of a university hospital and the unmet needs of the patients' relatives related to nursing care were investigated. In the study, 225 nurses and 222 relatives of patients constituted the sample group of this study. Three separate forms were used in the study, namely, Nurse and Patient Relative Identification Form, the Maslach Burnout Inventory and the Nursing Services Satisfaction Inventory. In the study, burnout levels of the nurses were found to be high. Conditions like younger ages, scarcity of experience in the profession, lower levels of education, having chosen the profession and the unit they work in not willingly and working in environments like intensive care increase the burnout and as a result, expectations of the relatives of patients from nursing care are not fully met. Some suggestions have been made to make some regulations to prevent the burnout of nurses and to increase the satisfaction of relatives.
Jatlaoui, Tara C; Ewing, Alexander; Mandel, Michele G; Simmons, Katharine B; Suchdev, Danielle B; Jamieson, Denise J; Pazol, Karen
Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2013. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2013, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2004-2013. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 664,435 abortions were reported to CDC for 2013. Of these abortions, 98.2% were from the 47 reporting areas that provided data every year during 2004-2013. Among these 47 reporting areas, the abortion rate for 2013 was 12.5 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 200 abortions per 1,000 live births. From 2012 to 2013, the total number, rate, and ratio of reported abortions decreased 5%. From 2004 to 2013, the total number, rate, and ratio of reported abortions decreased 20%, 21%, and 17%, respectively. In 2013, all three measures reached their lowest level for the entire period of analysis (2004-2013). In 2013 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2013, women aged 20-24 and 25-29 years accounted for 32.7% and 25.9% of all abortions, respectively, and had abortion rates of 21.8 and 18.2 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.8%, 9.2%, and 3.6% of all abortions, respectively, and had abortion rates of 11.8, 7.0, and 2
Pazol, Karen; Creanga, Andreea A; Jamieson, Denise J
Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2012. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2012, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2003-2012. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 699,202 abortions were reported to CDC for 2012. Of these abortions, 98.4% were from the 47 reporting areas that provided data every year during 2003-2012. Among these same 47 reporting areas, the abortion rate for 2012 was 13.2 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 210 abortions per 1,000 live births. From 2011 to 2012, the total number and ratio of reported abortions decreased 4% and the abortion rate decreased 5%. From 2003 to 2012, the total number, rate, and ratio of reported abortions decreased 17%, 18%, and 14%, respectively, and reached their lowest level in 2012 for the entire period of analysis (2003-2012). In 2012 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2012, women aged 20-24 and 25-29 years accounted for 32.8% and 25.4% of all abortions, respectively, and had abortion rates of 23.3 and 18.9 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.4%, 9.1%, and 3.7% of all abortions, respectively, and had abortion rates of
Miquel Capó Rn, I
The objectives of this study are to analyse nursing interventions regarding noise and lighting that influence neurodevelopment of the preterm infant in the Neonatal Intensive Care Unit. A review of the literature was performed using the databases: Cuiden Plus, PubMed, IBECS and Cochrane Library Plus. The inclusion and exclusion criteria were established in accordance with the objectives and limits used in each database. Of the 35 articles used, most were descriptive quantitative studies based on the measurement of sound pressure levels and lighting in the Neonatal Intensive Care Units. The countries included in this study are Brazil and the United States, and the variables analysed were the recording the times of light and noise. Based on the high levels of light and noise recorded in the Neonatal Intensive Care Units, nursing interventions that should be carried out to reduce them are described. The evidence indicates that after the implementation of these interventions, the high levels of both environmental stimuli are reduced significantly. Despite the extensive literature published on this problem, the levels of light and noise continue to exceed the recommended limits. Therefore, nurses need to increase and enhance their efforts in this environment, in order to positively influence neurodevelopment of premature newborn. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Casida, Jesus M; Crane, Patrick C; Walker, Tara L; Wargo, Lisa M
The leadership-culture phenomenon, a known explanatory construct for organizational performance, is understudied in nursing. Building on our previous work, we further addressed this knowledge gap through explorations of demographics and hospital variables which may have a significant influence on staff nurses' (SNs) perceptions of their nurse managers' (NMs) leadership and nursing unit culture. Furthermore, we explored the extent to which the NMs' leadership predicted specific cultures which typify nursing unit effectiveness. Using dissertation data provided by278 SNs, we found that SNs educated at the baccalaureate level or higher had favorable perceptions of their nursing unit performance and viewed their NMs' leadership differently than the SNs with diploma or associate degrees. The frequent portrayals of transformational (TFL) leadership behaviors (e.g., visionary) by the NMs were paramount in shaping culture traits which exemplify high performance outcomes. TFL leaders were more likely to shape unit cultures which are flexible and adaptive to the environmental challenges within and outside the nursing unit. Thus, the type of NMs' leadership and unit culture may provide an added value in explaining the performance level in patient care units which consequently affects the overall hospital/organizational outcomes. Implications for research and leadership practices are presented.
global nursing conference in Kigali, it was followed by a response from Rwanda, ... School of Nursing and Midwifery, College of Medi- ... ing internet application that shifts the images of the ... to countries that already have high levels of doctoral ... D., personal communication). ..... affect influence on the health systems. This.
Pope, Diana S; Miller-Klein, Erik T
Hospitals have complex soundscapes that create challenges to patient care. Extraneous noise and high reverberation rates impair speech intelligibility, which leads to raised voices. In an unintended spiral, the increasing noise may result in diminished speech privacy, as people speak loudly to be heard over the din. The products available to improve hospital soundscapes include construction materials that absorb sound (acoustic ceiling tiles, carpet, wall insulation) and reduce reverberation rates. Enhanced privacy curtains are now available and offer potential for a relatively simple way to improve speech privacy and speech intelligibility by absorbing sound at the hospital patient's bedside. Acoustic assessments were performed over 2 days on two nursing units with a similar design in the same hospital. One unit was built with the 1970s' standard hospital construction and the other was newly refurbished (2013) with sound-absorbing features. In addition, we determined the effect of an enhanced privacy curtain versus standard privacy curtains using acoustic measures of speech privacy and speech intelligibility indexes. Privacy curtains provided auditory protection for the patients. In general, that protection was increased by the use of enhanced privacy curtains. On an average, the enhanced curtain improved sound absorption from 20% to 30%; however, there was considerable variability, depending on the configuration of the rooms tested. Enhanced privacy curtains provide measureable improvement to the acoustics of patient rooms but cannot overcome larger acoustic design issues. To shorten reverberation time, additional absorption, and compact and more fragmented nursing unit floor plate shapes should be considered.
Diana S Pope
Full Text Available Hospitals have complex soundscapes that create challenges to patient care. Extraneous noise and high reverberation rates impair speech intelligibility, which leads to raised voices. In an unintended spiral, the increasing noise may result in diminished speech privacy, as people speak loudly to be heard over the din. The products available to improve hospital soundscapes include construction materials that absorb sound (acoustic ceiling tiles, carpet, wall insulation and reduce reverberation rates. Enhanced privacy curtains are now available and offer potential for a relatively simple way to improve speech privacy and speech intelligibility by absorbing sound at the hospital patient′s bedside. Acoustic assessments were performed over 2 days on two nursing units with a similar design in the same hospital. One unit was built with the 1970s′ standard hospital construction and the other was newly refurbished (2013 with sound-absorbing features. In addition, we determined the effect of an enhanced privacy curtain versus standard privacy curtains using acoustic measures of speech privacy and speech intelligibility indexes. Privacy curtains provided auditory protection for the patients. In general, that protection was increased by the use of enhanced privacy curtains. On an average, the enhanced curtain improved sound absorption from 20% to 30%; however, there was considerable variability, depending on the configuration of the rooms tested. Enhanced privacy curtains provide measureable improvement to the acoustics of patient rooms but cannot overcome larger acoustic design issues. To shorten reverberation time, additional absorption, and compact and more fragmented nursing unit floor plate shapes should be considered.
Santos, E R; de Barros, J R; Baraldi, M M; Minto, C A; Dupas, G
The present work reports an initial process of nursing assistance systematization developed in a Pediatric Unit of a medium size hospital in São Carlos-SP, considering the actual human resources and the type of approach adopted by the institution on the assistance given to the hospitalized child. A Routine Manual was elaborated based on the literature and with the staff participation, and after that, a training was realized with these employees, starting from routines previously sketched, using groupal dynamics that looked forward to rescue the knowledge that they already had about the themes. The work considered the employees opinion about their participation in the systematization process.
Full Text Available ABSTRACT Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP in Greek Coronary Care Units (CCUs. Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7. The most highly valued component of satisfaction was “Pay”, followed by “Task requirements”, “Interaction”, “Professional status”, “Organizational policies” and “Autonomy”. NAS, CNIS and TISS-28 were negatively correlated (p≤0.04 with the following work components: “Autonomy”, “Professional status”, “Interaction” and “Task requirements”. Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.
Mogale L. Mmamma
Full Text Available Background: Staff turnover of professional nurses remains a concern for public and private hospitals management because it has an impact on the morale of nurses and it may also lead to poor patient care.Objectives: The objectives of this study were to explore and describe the experiences of nursing unit managers with regard to the turnover of professional nurses who were under their supervision.Method: A qualitative, explorative, descriptive research design was used to determine the experiences of nursing unit managers related to the turnover of professional nurses. Data collection was done by using semi-structured one-to-one interviews with professional nurses .Two groups of participants were interviewed: Those working day duty (n = 9 and those working night duty (n = 3 who were at work on the anticipated days for data collection.Results: The findings revealed that every unit was experiencing a shortage of professional nurses, which caused other nurses to work overtime with an inevitable increase in workload. That led to tiredness, conflict amongst professional nurses, job dissatisfaction, and absenteeism which compromised nursing care. This resulted in patient dissatisfaction and sometimes led to deaths that could have been prevented.Conclusion: It is recommended that staff turnover should be addressed by the hospital top management implementing several strategies. For example, top management could ensure that staff members work in a healthy environment with resources that they need during the provision of care, address the effects of the staff turnover, support the staff members and refrain from putting pressure on nursing unit managers whilst they are attending to problems.
current government approach to the economy , then examining the current projections for United States’ spending from 2009 through 2019 and examining...manner and thereby strengthen the economy of the United States, this paper concludes with three examples that are predicated on the synergistic benefits associated with small reforms.
17 March 2005. 2 Homero Aridjis, "Survival of Indigenous Cultures in Mexico," 9 April 1998; available from <http://www.klys.se/worldconference/papers...HomeroAridjis.htm>;Internet; accessed 21 November 2004. 3Tania Carrasco, "Indigenous Peoples in the States of Chiapas, Guerrero and Oaxaca ," 2005...analysis by the State representatives from Chiapas, Guerrero and Oaxaca (3 Southern States). The plan reviewed possible options to reduce poverty and
Wicklander, Molly K.
The purpose of this review is to analyze the school nursing role within the National Healthy School Standard (NHSS) in the United Kingdom with a view toward clarifying and strengthening the role of school nurses globally. Within the National Healthy School Standard framework, school nurses serve an integral role in linking health and education…
U.S. Geological Survey, Department of the Interior — This map layer portrays the State boundaries of the United States, and the boundaries of Puerto Rico and the U.S. Virgin Islands. The map layer was created by...
Beltempo, M; Lacroix, G; Cabot, M; Blais, R; Piedboeuf, B
To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the risk of mortality or major morbidity among very preterm infants. Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth weight bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association with the composite outcome (mortality or major morbidity). Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval (CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99). High nursing provision ratio during NICU hospitalization is associated with a lower risk of a composite adverse outcome in very preterm infants.Journal of Perinatology advance online publication, 21 September 2017; doi:10.1038/jp.2017.146.
National Oceanic and Atmospheric Administration, Department of Commerce — Numbered series of NOAA publications that contain environmental information climate summaries and station normals. Each series contains a volume for each state,...
Bechtel, G A; Printz, V
The purpose of this study was to examine performance outcome measures of nurses who work on a general medical unit and those who work on specialized or modular units. A sample of 82 nurses were reassigned to patients in either specialty modules or a general medical unit. Findings suggest that large nursing units staffed according to modular groups based on common diagnosis may improve nursing care quality. Modular nurses assigned to patients on a general medical unit made more medication errors, charted nursing interventions less frequently, and were less likely to provide prompt PRN medication administration. Of concern is the care provided to chronically ill; elderly clients not admitted to a predetermined specialty module received the poorest nursing care. We support development of specialty nursing modules to replace large, general medical units, it does not measure the impact of retention, cost, or other key variables on nurse staffing. We suggest that large medical units be divided into specialty modules and that staff rotation to general medical units be minimized.
Costa, Rita de Almeida; Shimizu, Helena Eri
The purpose of this study was to identify and analyze tasks performed by nurses at inpatient units in a large general hospital in Brasilia, Federal District, which also functions as a training hospital. A quantitative, exploratory, descriptive study was carried out and involved a total of 612 hours of direct observation of the activities performed by 18 nurses at the General Medicine, Surgical, Pediatric and Maternity units. The tasks observed were classified as: administration, nursing care delivery, education and related to information system. Nurses dedicate a large part of their time to administrative tasks, followed by tasks related to nursing care delivery and information system, performing almost no educative tasks.
Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth
REVIEW QUESTION / OBJECTIVE The objective of this systematic review is to identify, appraise and synthesize the best available evidence on nursing students’ experiences of professional patient care encounters in a hospital unit. More specifically the research questions are: How do nursing students...... describe their experiences of professional patient care in a hospital unit? What kinds of experiences do nursing students have in professional patient care encounters? INCLUSION CRITERIA Types of participants This review will consider studies that include undergraduate and postgraduate nursing students...... experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing...
Kalisch, Beatrice J; Xie, Boqin; Ronis, David L
Teamwork is essential for patient safety and results in less missed nursing care. The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care. This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and 2 months after completion of the intervention. The sample for this study was the nursing staff on three medical-surgical units in three separate acute care hospitals (one unit in each hospital). Three nurses from each unit underwent a training program and then taught the skills and knowledge they acquired to the staff members on their units in three-hour-long sessions. The training involved staff role-playing scenarios based on teamwork problems that occur regularly on inpatient units in acute care hospitals followed by debriefing, which focused on teamwork behaviors (e.g., leadership, team orientation, backup, performance monitoring) and missed nursing care. Four measures were used to test the efficacy of this intervention: The Nursing Teamwork Survey, the MISSCARE Survey, and questions about the knowledge of and satisfaction with teamwork. Return rates for the surveys ranged from 73% to 84%. Follow-up tests individually comparing pretest, posttest, and delayed posttest were conducted within the mixed model and used the Bonferroni correction for multiple comparisons. Teamwork increased (F = 6.91, df = 259.01, p = .001) and missed care decreased (F = 3.59, df = 251.29, p = .03) over time. Nursing staff also reported a higher level of satisfaction with teamwork and an increase of teamwork knowledge after the intervention. The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.
Catell, Grace Manion
Community health nursing curriculum components in a sample of baccalaureate nursing programs were investigated. Questionnaires were sent to a sample of 12 National League of Nursing (NLN) accredited, generic, baccalaureate nursing programs representative of the four NLN regions in the United States. Community health nursing content in theory…
Casida, Jesus; Pinto-Zipp, Genevieve
The phenomena of leadership and organizational culture (OC) has been defined as the driving forces in the success or failure of an organization. Today, nurse managers must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex, and turbulent health care delivery system. In this study, researchers explored the relationship between nurse managers' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. The data from this study support that transformational and transactional contingent reward leaderships as nurse manager leadership styles that are associated with nursing unit OC that have the ability to balance the dynamics of flexibility and stability within their nursing units and are essential for maintaining organizational effectiveness. It is essential for first-line nursing leaders to acquire knowledge and skills on organizational cultural competence.
Settle, Peggy Doyle
Nurses working in a newborn intensive care unit report that treatment decision disagreements for infants in their care may lead to ethical dilemmas involving all health-care providers. Applying Rest's Four-Component Model of Moral Action as the theoretical framework, this study examined the responses of 224 newborn intensive care unit nurses to the Nurses Ethical Involvement Survey. The three most frequent actions selected were as follows: talking with other nurses, talking with doctors, and requesting a team meeting. The multiple regression analysis indicates that newborn intensive care unit nurses with greater concern for the ethical aspects of clinical practice (p = .001) and an increased perception of their ability to influence ethical decision making (p = .018) were more likely to display Nurse Activism. Future research is necessary to identify other factors leading to and inhibiting Nurse Activism as these findings explained just 8.5% of the variance.
Mason, Virginia M; Leslie, Gail; Clark, Kathleen; Lyons, Pat; Walke, Erica; Butler, Christina; Griffin, Martha
Preparation for replacing the large proportion of staff nurses reaching retirement age in the next few decades in the United States is essential to continue delivering high-quality nursing care and improving patient outcomes. Retaining experienced critical care nurses is imperative to successfully implementing the orientation of new inexperienced critical care nurses. It is important to understand factors that affect work engagement to develop strategies that enhance nurse retention and improve the quality of patient care. Nurses' experience of moral distress has been measured in medical intensive care units but not in surgical trauma care units, where nurses are exposed to patients and families faced with sudden life-threatening, life-changing patient consequences.This pilot study is a nonexperimental, descriptive, correlational design to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses' work engagement. This is a partial replication of Lawrence's dissertation. The study also asked nurses to describe sources of moral distress and self-care strategies for coping with stress. This was used to identify qualitative themes about the nurse experiences. Jean Watson's theory of human caring serves as a framework to bring meaning and focus to the nursing-patient caring relationship.A convenience sample of 26 of 34 eligible experienced surgical intensive care unit trauma nurses responded to this survey, indicating a 77% response rate. Twenty-seven percent of the nurses scored high, and 73% scored average on compassion satisfaction. On compassion fatigue, 58% scored average on burnout and 42% scored low. On the secondary traumatic stress subscale, 38% scored average, and 62% scored low. The mean moral distress situations subscale score was 3.4, which is elevated. The mean 9-item Utrecht Work Engagement Scale total score, measuring work engagement, was 3.8, which is considered low
Edward, Karen-leigh; Warelow, Philip; Hemingway, Steve; Hercelinskyj, Gylo; Welch, Anthony; McAndrew, Sue; Stephenson, John
Background There has been much debate by both academics and clinical agencies about the motivations and abilities of nurse graduates to work in mental health nursing. The aim of this study was to recruit student nurses from a dedicated mental health nursing program in the United Kingdom (UK) and a comprehensive nursing program in Australia and illuminate their motivations towards considering mental health nursing as a career choice. Methods This study comprised of two UK and four Australian S...
Noh, Hyun Kyung; Lee, Eunjoo
The purpose of this study was to identify NANDA-I, Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC; NNN) linkages used by Korean nursing students during their clinical practice in medical-surgical units. A comparative descriptive research design was used to measure the effects of nursing interventions from 153 nursing students in South Korea. Nursing students selected NNN using a Web-based nursing process documentation system. Data were analyzed by paired t-test. Eighty-two NANDA-I diagnoses, 116 NOC outcomes, and 163 NIC interventions were identified. Statistically significant differences in patients' preintervention and postintervention outcome scores were observed. By determining patient outcomes linked to interventions and how the degree of outcomes change after interventions, the effectiveness of the interventions can be evaluated. © 2014 NANDA International, Inc.
A well-documented and growing problem impacting the nursing shortage in the United States is the increasing shortage of qualified nursing faculty. Many factors contribute to the nursing faculty shortage such as retirement, dissatisfaction with the nursing faculty role and low salary compensation (American Association of Colleges of Nursing (AACN),…
Ali Akbar Vaezi
Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.
Corporate involvement in social welfare represents a third stage in the evolution of welfare institutions in the United States, following the voluntary sector and the welfare state. Examining health and welfare corporations reveals rapid growth and consolidation in nursing homes, hospital management, health maintenance organizations, child care,…
Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.
White, Marjorie A; Elder, Jennifer H; Paavilainen, Eija; Joronen, Katja; Helgadóttir, Helga L; Seidl, Ann
Understanding the dynamics of contemporary, postmodern families and how these relate to health is critically important to nurses and other health care providers throughout the world. Much can be learned by studying not only one's own culture but also other countries. Thus, the purpose of this study was to compare family dynamics of families in the United States, Finland and Iceland. To date relatively little has been published related to families in these Nordic countries. Six family dimensions in Barnhill's Family Health Cycle served as the theoretical framework. Adult respondents (n = 567) purposively selected from varied community groups, completed the Family Dynamics Measure II (FDM II) and a sociodemographic questionnaire. Main findings from the three countries were positive family dynamics, with mutuality contributing the strongest factor to partially confirm the theoretical propositions in Barnhill's Family Health Cycle. Respondents from all countries reported (1) clear communication and flexibility that contribute to mutuality; (2) younger age of respondents and increased education that were associated with more positive family dynamics; and (3) larger families associated with more negative dynamics. Mixed reports occurred according to gender, with Nordic men tending to perceive some negative dimensions. Marriage was important for more positive family dynamics only in the United States. Families in the United States and in Iceland had in common more negative family dynamics during illnesses. Problems and changes affected mostly families in the United States. In general, families in Finland and Iceland had greater strengths than in the United States. This benchmark study offers information for health practitioners to assist families, as well as contribute to the improvement of family social policies, especially in the United States.
Alessandra Bassalobre Garcia
Full Text Available Objective: to understand the strategies used by nursing technicians in order to face the occupational suffering in an emergency room. Methods: qualitative study carried out in an emergency room of a high complexity hospital located in the north of Paraná state. Data were collected through semi-structured interviews with 12 nursing technicians. The analysis relied on content analysis procedures. Results: respondents revealed as individual strategies to face suffering: try not to get involved with the patient; separation between professional and personal life; and spirituality/religion as support for coping. The collective strategies described by respondents included: action planning for unexpected events in this unit; creating a supportive environment; and attempt to obtain recognition of headship. Conclusion: individual and collective strategies were used consciously by workers and should be encouraged by managers to face the occupational suffering.
National Oceanic and Atmospheric Administration, Department of Commerce — The 2010 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...
U.S. Geological Survey, Department of the Interior — Mineral facilities and operations outside the United States compiled by the National Minerals Information Center of the USGS. This representation combines source...
@@ Beijing Petroleum Machinery Plant(BPM) of CNPC and Rowan Drilling Company Inc, one of the most powerful drilling service and driller manufacturing companies in the United States signed a petroleum equipment contract on December 9 in Beijing.
U.S. Geological Survey, Department of the Interior — Rest areas in the western United States. Data was collected from various data sources including georeferenced locations obtained from other agencies, digitizied...
National Oceanic and Atmospheric Administration, Department of Commerce — The U.S. Interagency Elevation Inventory displays high-accuracy topographic and bathymetric data for the United States and its territories. The project is a...
... Disparities Report Healthy People Older Americans Health Report Rural-Urban Chartbook NCHS Health, United States, 2015 - Men's Health ... Disparities Report Healthy People Older Americans Health Report Rural-Urban Chartbook File Formats Help: How do I view ...
U.S. Geological Survey, Department of the Interior — Agricultural land cover for the western United States. This dataset was developed from Sagestitch, the Eastern Washington Shrubsteppe Mapping Project, and several...
U.S. Geological Survey, Department of the Interior — Hydrologic landscape regions (HLRs) in the United States were delineated by using geographic information system (GIS) tools and statistical methods including...
United States both militarily and by setting the terms of trade. While cultural and ideological affinities with European democra- cies played...military establishments (Japan, Russia, India, South Korea, Vietnam, Taiwan, Indonesia , Malaysia, Singapore) can check possible military expansion when
... in Children Treatment Vaccines Statistics Related Links TB in Children in the United States TB disease in children under ... person with infectious TB disease. Testing for TB in Children In the absence of symptoms, usually the ...
National Oceanic and Atmospheric Administration, Department of Commerce — The 2014 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...
National Oceanic and Atmospheric Administration, Department of Commerce — The 2009 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...
National Oceanic and Atmospheric Administration, Department of Commerce — The 2011 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...
National Oceanic and Atmospheric Administration, Department of Commerce — The 2012 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...
U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey (USGS) modeled the distribution of terrestrial ecosystems for the contiguous United States using a standardized, deductive approach to...
U.S. Geological Survey, Department of the Interior — We evaluated the fragmentation of the western United States by anthropogenic features. The addition of roads, railroads, and power lines to wildlands, and the...
Patey, Andrea M; Curran, Janet A; Sprague, Ann E; Francis, Jill J; Driedger, S Michelle; Légaré, France; Lemyre, Louise; Pomey, Marie-Pascale A; Grimshaw, Jeremy M
Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA. We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses' behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social
Arizona State Dept. of Education, Phoenix.
Part of a health occupations program, these instructional units consist of materials for use by those who are studying to become practical nurses. Covered in the units are the following: the nursing care of mothers and newborns (obstetrics, prenatal care and complications, patient needs, care of the newborn, prematurity, medications, and cultural…
Kellogg, E. G.
This teachers guide attempts to facilitate the study of the United States through a conceptual approach and multimedia instruction in a spiral curriculum. There are five units: 1) Natural Setting --location, climate, terrain, water, soil, and economic and esthetic value, and conservation; 2) Historial Development --North American Indian cultures,…
This dissertation is about how political parties formed in the world's first mass democracy, the United States. I trace the process of party formation from the bottom up. First, I ask: How do individuals become engaged in politics and develop political affiliations? In most states, throughout the antebellum era, the county was the primary unit of political administration and electoral representation. Owing to their small size, contiguity, and economic homogeneity, I expect that each county's ...
May 2007 was a record-setting month in Georgia. Typically a dry month in this southern state, May 2007 was exceptionally so, with many locations setting record-low rainfall records and some receiving no rain at all, said state climatologist David Emory Stooksbury on GeorgiaDrought.org. The lack of rain slowed plant growth, as shown in this vegetation index image. The Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite collected the data used to make this image between May 9 and May 24, 2007. The image shows vegetation conditions compared to average conditions observed from 2000 through 2006. Areas in which plants are more sparse or are growing more slowly than average are brown, while better-than-average growth is green. Georgia and its neighbors (South Carolina, Alabama, and Florida) are all brown, an indication that the lack of rainfall is suppressing plant growth. The gray area in southern Georgia and northern Florida shows where MODIS could not collect valid vegetation measurements, either because of clouds or smoke. In this case, the area corresponds with land that burned during this period and was probably masked by smoke. NASA image created by Jesse Allen, Earth Observatory, using data provided by Inbal Reshef, Global Agricultural Monitoring Project.
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States person. 596.313 Section... General Definitions § 596.313 United States person. The term United States person means any United States... States, or any person in the United States....
Boyd, M; Collins, L; Pipitone, J; Balk, E; Kapustay, P
Recruitment and retention of nurses is the most significant issue facing nursing administrators, educators, researchers and clinicians in the ongoing nursing shortage in the United States today. It has been cited in the literature that American nurses feel that job satisfaction is a major issue in retaining qualified nurses in hospitals. Satisfaction occurs when nurse expectations are matched with the hospital's vision and values. It is for this purpose that the authors have chosen theory Z as a hospital management model to coincide with the institution of the Marker Professional Practice Model to increase job satisfaction (autonomy) in hospital-based nurses. There are four 'hidden' challenges in health care today. They are: (a) fundamental changes occurring within the profession and practice of nursing; (b) the expanded role of women in management; (c) ethical dilemmas related to advances in medical technologies; and (d) the difficulty for health care managers in the United States to make changes related to the above three challenges. The authors feel that it is inherent to the nursing profession to combine existing theories and models to enhance the retention of nurses to the profession.
Organizational culture consists of the deep underlying assumptions, beliefs, and values that are shared by members of the organization and typically operate unconsciously. The four organizational culture traits of the Denison Organizational Culture Model (DOCM) are characteristics of organizational effectiveness, which include adaptability, involvement, consistency, and mission. Effective organizations demonstrate high levels of the four cultural traits which reflect their ability to balance the dynamic tension between the need for stability and the need for flexibility within the organization. The Denison Organizational Culture Survey (DOCS) is a measurement tool that was founded on the theoretical framework of the DOCM, and in the field of business, is one of the most commonly used tools for measuring organizational culture. The DOCS offers a promising approach to operationalizing and measuring the link between organizational culture and organizational effectiveness in the context of nursing units.
Santiago, Lawrence A.
A severe and worsening nursing shortage exists in the United States. Increasing numbers of new graduate nurses are necessary to meet this demand. To address the concerns of increased nursing demand, leaders of nursing schools must ensure larger numbers of nursing students graduate. Prior to practicing as registered nurses in the United States,…
The Institute of Medicine and American Association of Colleges of Nursing are calling for curriculum redesign that prepares nursing students with the requisite knowledge and skills to provide safe, high quality care. The purpose of this project was to improve nursing students' knowledge of quality and safety by integrating Quality and Safety Education for Nurses into clinical nursing education through development of a dedicated education unit. This model, which pairs nursing students with front-line nursing staff for clinical experiences, was implemented on a medical floor in an acute care hospital. Prior to implementation, nurses and students were educated about the dedicated education unit and quality and safety competencies. During each clinical rotation, students collaborated with their nurses on projects related to these competencies. Students' knowledge was assessed using questions related to quality and safety. Students who participated in the dedicated education unit had higher scores than those with traditional clinical rotations. Focus groups were held mid-semester to assess nurses' perceptions of the experience. Five themes emerged from the qualitative data including thirsting for knowledge, building teamwork and collaboration, establishing trust and decreasing anxiety, mirroring organization and time management skills, and evolving confidence in the nursing role. Copyright © 2015 Elsevier Ltd. All rights reserved.
Smith, C A; Simon, A J; Belles, R D
A flow chart depicting energy flow in the transportation sector of the United States economy in 2005 has been constructed from publicly available data and estimates of national energy use patterns. Approximately 31,000 trillion British Thermal Units (trBTUs) of energy were used throughout the United States in transportation activities. Vehicles used in these activities include automobiles, motorcycles, trucks, buses, airplanes, rail, and ships. The transportation sector is powered primarily by petroleum-derived fuels (gasoline, diesel and jet fuel). Biomass-derived fuels, electricity and natural gas-derived fuels are also used. The flow patterns represent a comprehensive systems view of energy used within the transportation sector.
Camelo, Silvia Helena Henriques
This study aimed to identify and analyze nurses' competences to work at Intensive Care Units-ICU. An integrative review method was used, and data were collected in LILACS, SciELO and BDENF, from August to October 2010. Ten articles were identified, published in the last 12 years. Data grouping permitted the construction of thematic units related to nurses' competences: nursing care management, high-complexity nursing care delivery, decision making, leadership, communication, continuing/permanent education, human resource management, material resource management. The professional competences identified can support the outline of guidelines to constitute the profile of nursing working in intensive care units and drive/mobilize the improvement of nursing care practices.
Sun, Eric C; Miller, Thomas R; Halzack, Nicholas M
In the United States, anesthesia care can be provided by anesthesiologists or nurse anesthetists. Since 2001, 17 states have exercised their right to "opt-out" of the federal requirement that a physician supervise the administration of anesthesia by a nurse anesthetist, with the majority citing increased access to anesthesia care as the rationale for their decision. By using Medicare data, we found that most (4 of 5) cohorts of "opt-out" states likely experienced smaller growth in anesthesia utilization rates compared with non-"opt-out" states, suggesting that opt-out was not associated with an increase in access to anesthesia care.
Griffith, Jayne; Blaney, David; Shadomy, Sean; Lehman, Mark; Pesik, Nicki; Tostenson, Samantha; Delaney, Lisa; Tiller, Rebekah; DeVries, Aaron; Gomez, Thomas; Sullivan, Maureen; Blackmore, Carina; Stanek, Danielle; Lynfield, Ruth
Inhalation anthrax occurred in a man who vacationed in 4 US states where anthrax is enzootic. Despite an extensive multi-agency investigation, the specific source was not detected, and no additional related human or animal cases were found. Although rare, inhalation anthrax can occur naturally in the United States.
Hua, Ying; Becker, Franklin; Wurmser, Teri; Bliss-Holtz, Jane; Hedges, Christine
Studies investigating factors contributing to improved quality of care have found that effective team member communication is among the most critical and influential aspects in the delivery of quality care. Relatively little research has examined the role of the physical design of nursing units on communication patterns among care providers. Although the concept of decentralized unit design is intended to increase patient safety, reduce nurse fatigue, and control the noisy, chaotic, and crowded space associated with centralized nursing stations, until recently little attention has been paid to how such nursing unit designs affected communication patterns or other medical and organizational outcomes. Using a pre/post research design comparing more centralized or decentralized unit designs with a new multi-hub design, the aim of this study was to describe the relationship between the clinical spatial environment and its effect on communication patterns, nurse satisfaction, distance walked, organizational outcomes, patient safety, and patient satisfaction. Hospital institutional data indicated that patient satisfaction increased substantially. Few significant changes were found in communication patterns; no significant changes were found in nurse job satisfaction, patient falls, pressure ulcers, or organizational outcomes such as average length of stay or patient census.
Stephens, Caroline E; Harris, Melodee; Buron, Bill
Advanced Practice Registered Nurses (APRNs) must be prepared to care for the rapidly increasing numbers of older adults with mental health needs. All 363 graduate nursing programs in the United States were surveyed regarding the nature and extent of geropsychiatric nursing (GPN) content across program curricula and their perceptions of the influence that the APRN Consensus Model has exerted on preparing the next generation of APRNs to meet the growing needs of the older adult population. Of the 202 schools responding, 138 reported GPN content in one or more clinical programs, with the majority of content in non-PMHNP programs. Only 17 schools reported offering a GPN program, track, or minor. The majority of schools (n = 169) perceived that they were adequately well-prepared to meet the APRN Consensus Model's guidelines regarding inclusion of aging-related didactic and clinical educational experiences in all APRN education programs; nearly two thirds (n = 132) perceived a moderate to significant influence of the Consensus Model on institutional infusion of GPN into curricula. Compared with a similar survey 10 years ago, there was little change in the proportion of schools reporting GPN in clinical programs and few schools provide GPN programs, tracks, or minors. Implications for nursing education and practice are discussed.
Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura
Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.
Orihuela Casarra, Roser; Heras Tebar, Antonio; Pozo Gil, Maria
A diabetic foot is the most important cause of disability and loss of life quality among diabetics. To inspect a diabetic's feet and to explore his/her protective sensibility capability with a 5.07 monofilament are efficient methods to detect the risk of lesions. The authors' objective was to discover if our Primary Health Care Unit utilizes this instrument; therefore, we carried out a poll among all the nurses in our unit. 79% of these nurses are aware of the 5.07 monofilament; 62% have this monofilament available for their use; 55% stated they utilize it. The primary reasons to not use this monofilament are its unavailability and a lack of knowledge regarding it. Priority must be given to facilitate the availability of this instrument and to promote among nurses an understanding how to correctly utilize a 5.07 monofilament.
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States person. 560.314 Section... § 560.314 United States person. The term United States person means any United States citizen, permanent resident alien, entity organized under the laws of the United States (including foreign branches), or...
Rehab Hani Elkazaz; Abeer Elsayed Berma
Stress is one of the main factors affecting one's efficiency as well as staff health and quality of nursing services. Neonatal units can be stressful environments for nurses, infants and families as well. Since there is no evidence in this regard in Egypt. Aim of the study: to determine the relationship between stress and self-efficacy among staff nurses in neonatal intensive care units (NICU) in Port Said. Method: This was a descriptive correlation study including thirty three nurses wor...
Gerdprasert, Sailom; Pruksacheva, Tassanee; Panijpan, Bhinyo; Ruenwongsa, Pintip
First clinical exposures are stressful situations for nursing students, especially, when practicing on the labour ward. The purpose of this study was to develop intrapartum nursing care web-based learning to facilitate students' acquisition of conceptual knowledge and performance skills. This web-based learning unit integrated the 5E-model and information technology with the lecture content. Eighty four nursing students were recruited in the study. The control group received traditional teaching, while the experimental group was supplemented with the web-based learning unit on intrapartum nursing care. The results showed that the students in the experimental group had significant higher scores in conceptual knowledge and performance skill. The students also had significant lower scores in ignorance - related stress when compared to those of the control group. The students supplemented with the web-based course showed a strong positive attitude toward the new learning method.
Full Text Available Critical care patients benefit from the attention of nursing personnel with a high competence level. The aim of the study was to describe and evaluate the self-assessed basic competence of intensive care unit nurses and related factors. A cross-sectional survey design was used. A basic competence scale (Intensive and Critical Care Nursing Competence Scale version 1, Likert scale 1–5, 1 = poor and 5 = excellent was employed among Finnish intensive care unit nurses (n=431. Intensive care unit nurses’ self-assessed basic competence was good (mean 4.19, SD 0.40. The attitude and value base of basic competence was excellent whereas experience base was the poorest compared to the knowledge base and skill base of intensive and critical care nursing. The strongest factor explaining nurses’ basic competence was their experience of autonomy in nursing care (F value 60.85, β 0.11, SE 0.01, and P≤0.0001. Clinical competence was self-rated as good. Nurses gave their highest competence self-ratings for ICU patient care according to the principles of nursing care. The ICU nurses also self-rated their professional competence as good. Collaboration was self-rated as the best competence. In basic and continuing education and professional self-development discussions it is meaningful to consider and find solutions for how to improve nurses’ experienced autonomy in nursing.
Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...
glass fiber. The light signals are then decoded at the end of the fiber by a special optic decoder /encoder. This allows for the light signal to be...CDMA technology while Cingular offers it through the HSDPA/ GSM technology. One quarter of the United States’ Internet users have a cell phone that...well Cingular 900 Kbps 100 Kbps $79.00 HSDPA/ GSM 1 yr contract Table 13. Unlimited Cellular Broadband Plans in the United States (From PCWorld.com
Langer, William H.
Crushed stone and sand and gravel are the two main sources of natural aggregates. These materials are commonly used construction materials and frequently can be interchanged with one another. They are widely used throughout the United States, with every State except two producing crushed stone. Together they amount to about half the mining volume in the United States. Approximately 96 percent of sand and gravel and 77 percent of the crushed stone produced in the United States are used in the construction industry. Natural aggregates are widely distributed throughout the United States in a variety of geologic environments. Sand and gravel deposits commonly are the results of the weathering of bedrock and subsequent transportation and deposition of the material by water or ice (glaciers). As such, they commonly occur as river or stream deposits or in glaciated areas as glaciofluvial and other deposits. Crushed stone aggregates are derived from a wide variety of parent bedrock materials. Limestone and other carbonates account for approximately three quarters of the rocks used for crushed stone, with granite and other igneous rocks making up the bulk of the remainder. Limestone deposits are widespread throughout the Central and Eastern United States and are scattered in the West. Granites are widely distributed in the Eastern and Western United States, with few exposures in the Midwest. Igneous rocks (excluding granites) are largely concentrated in the Western United States and in a few isolated localities in the East. Even though natural aggregates are widely distributed throughout the United States, they are not universally available for consumptive use. Some areas are devoid of sand and gravel, and potential sources of crushed stone may be covered with sufficient unconsolidated material to make surface mining impractical. In some areas many aggregates do not meet the physical property requirements for certain uses, or they may contain mineral constituents that react
Logan, T K; Walker, Robert; Hunt, Gretchen
The topic of modern-day slavery or human trafficking has received increased media and national attention. However, to date there has been limited research on the nature and scope of human trafficking in the United States. This article describes and synthesizes nine reports that assess the U.S. service organizations' legal representative knowledge of, and experience with, human trafficking cases, as well as information from actual cases and media reports. This article has five main goals: (a) to define what human trafficking is, and is not; (b) to describe factors identified as contributing to vulnerability to being trafficked and keeping a person entrapped in the situation; (c) to examine how the crime of human trafficking differs from other kinds of crimes in the United States; (d) to explore how human trafficking victims are identified; and, (e) to provide recommendations to better address human trafficking in the United States.
Beltempo, Marc; Blais, Régis; Lacroix, Guy; Cabot, Michèle; Piedboeuf, Bruno
Objective This study aims to assess the association of nursing overtime, nurse staffing, and unit occupancy with health care-associated infections (HCAIs) in the neonatal intensive care unit (NICU). Study Design A 2-year retrospective cohort study was conducted for 2,236 infants admitted in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database "Logibec" and combined to the patient outcomes database. Median values for the nursing overtime hours/total hours worked ratio, the available to recommended nurse staffing ratio, and the unit occupancy rate over 3-day periods before HCAI were compared with days that did not precede infections. Adjusted odds ratios (aOR) that control for the latter factors and unit risk factors were also computed. Results A total of 122 (5%) infants developed a HCAI. The odds of having HCAI were higher on days that were preceded by a high nursing overtime ratio (aOR, 1.70; 95% confidence interval [95% CI], 1.05-2.75, quartile [Q]4 vs. Q1). High unit occupancy rates were not associated with increased odds of infection (aOR, 0.85; 95% CI, 0.47-1.51, Q4 vs. Q1) nor were higher available/recommended nurse ratios (aOR, 1.16; 95% CI, 0.67-1.99, Q4 vs. Q1). Conclusion Nursing overtime is associated with higher odds of HCAI in the NICU. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Mealer, Meredith; Jones, Jacqueline; Newman, Julia; McFann, Kim K; Rothbaum, Barbara; Moss, Marc
ICU nurses are repeatedly exposed to work related stresses resulting in the development of psychological disorders including posttraumatic stress disorder and burnout syndrome. Resilience is a learnable multidimensional characteristic enabling one to thrive in the face of adversity. In a national survey, we sought to determine whether resilience was associated with healthier psychological profiles in intensive care unit nurses. Surveys were mailed to 3500 randomly selected ICU nurses across the United States and included: demographic questions, the Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and the Connor-Davidson Resilience Scale. Overall, 1239 of the mailed surveys were returned for a response rate of 35%, and complete data was available on a total of 744 nurses. Twenty-two percent of the intensive care unit nurses were categorized as being highly resilient. The presence of high resilience in these nurses was significantly associated with a lower prevalence of posttraumatic stress disorder, symptoms of anxiety or depression, and burnout syndrome (resilience was independently associated with a lower prevalence of posttraumatic stress disorder (presilience was independently associated with a lower prevalence of posttraumatic stress disorder and burnout syndrome in intensive care unit nurses. Future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psychological profile. Copyright Â© 2011 Elsevier Ltd. All rights reserved.
Maurício, Luiz Felipe Sales; Okuno, Meiry Fernanda Pinto; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Belasco, Angélica Gonçalves Silva; Batista, Ruth Ester Assayag
ABSTRACT Objective: assess the autonomy, control over environment, and organizational support of nurses' work process and the relationships between physicians and nurses in critical care units. Method: cross-sectional study conducted with 162 nurses working in the intensive care units and emergency service of a university hospital. The workers' satisfaction with their work environment was assessed using Brazilian Nursing Work Index - Revised, translated and adapted for the Brazilian culture. Results: average age was 31.6 ± 3.9 years; 80.2% were women; 68.5% Caucasians and 71.6% worked in intensive care units. The nurses considered autonomy (2.38 ± 0.64) and their relationship with physicians (2.24 ± 0.62) to be characteristics of the work environment that favored professional practice. Control over environment (2.78 ± 0.62) and organizational support (2.51 ± 0.54), however, were considered to be unfavorable. No statistically significant differences were found between the units based on the scores obtained by the professionals on the Brazilian Nursing Work Index - Revised. Conclusion: autonomy, relationship between physicians and nurses, and organizational support were considered by the units to be characteristics that favored nurses' professional practices. On the other hand, control over environment and organizational support were considered unfavorable. PMID:28301034
Cox Sullivan, Sheila; Norris, Mitzi R; Brown, Lana M; Scott, Karen J
To examine the nurse manager perspective surrounding implementation of unit level shared governance in one Veterans Health Administration facility. Nursing shared governance is a formal model allowing nursing staff decision-making input into clinical practice, quality improvement, evidence-based practice and staff professional development. Unit level shared governance is a management process where decision authority is delegated to nursing staff at the unit level. Convenience sampling was used to recruit ten nurse managers who participated in face-to-face semi-structured interviews. Data were analysed using content analysis and constant comparison techniques. Demographic data were described using descriptive statistics. The participants included seven female and three male nurse managers with seven Caucasian and three African American. Participant quotes were clustered to identify sub-themes that were then grouped into four global themes to describe unit level shared governance. The global themes were: (1) motivation, (2) demotivation, (3) recommendations for success, and (4) outcomes. These research findings resonate with previous studies that shared governance may be associated with increased nurse empowerment, self-management, engagement, and satisfaction. These findings reflect the need for nurse managers to promote and recognize staff participation in unit level shared governance. © 2017 John Wiley & Sons Ltd.
Ethnocentrism is a problem. Pakistan lost Bangladesh in its 1971 civil war in part because West Pakistanis viewed Bengalis, who are the dominant ethnic...137. 64 Pakistan: Can the United States Secure an Insecure State? in the last few years of rapid growth, consumer price inflation surged to 25
Eduardo Fernández Guzmán
Full Text Available You might think that by definition the migrant labor plays in less profitable niches and meager social mobility. However, a large group of migrants in different economically developed countries have successfully launched businesses of diverse nature and volume. This is why entrepreneurship of migrants is an issue that has received increasing attention in recent years. Compared to other immigrant groups in the United States, Mexicans show low levels of entrepreneurial activity. The aim of this paper is to, through a general literature review of official statistical data, a preliminary analysis of mexican migrant entrepreneurship in the United States, that is to say in recent years has been growing in importance.
Savage, T A; Cullen, D L; Kirchhoff, K T; Pugh, E J; Foreman, M D
A statewide survey of nurses in perinatal centers was conducted to assess the prevalence of do-not-resuscitate (DNR) policies in neonatal intensive care units (NICUs) and to examine factors influencing nurses in those centers in their compliance with DNR orders. Three nurses in each of 10 perinatal centers were asked to complete a questionnaire on DNR policies and nurses' compliance and to respond to four hypothetical clinical situations. Eighteen of the 27 responding nurses reported the existence of a DNR policy. Factors affecting compliance with DNR orders were agreement that the infant should not be resuscitated (n = 24) or respect for the parents' wishes (n = 19). Nurses' intention to resuscitate despite a DNR order varied, depending on the description of the infant. Multiple regression analyses showed that subjective norms (beta = .41 to .82) rather than attitudes (beta = .17 to .39) exerted a more powerful influence on nurses' decisions not to resuscitate.
Full Text Available AIM: This study is carried out descriptively with the aim of determining occupational risks the nurses working in dialysis units and nephrology services. METHOD: 47 nurses working in dialysis and nephrology units of the hospitals in Erzurum were included in the study content. In the collection of the data, questionnaire form prepared in the light of literature and including the preventions taken by nurses themselves or their organizations against the professional risks they faced, or personal problems the nurses experienced, professional risk or professional-personal features was used. RESULTS: In the result of the study, it was detected that 48.9% of the nurses was at 28-32 age group, and that 38.3% of the nurses graduated from nursing higher school, and that 72.3% of the nurses worked in dialysis unit. It was found out that while practicing their professions, the nurses expressed that infection risk (97.9%, stress (83%, verbal abuse (80.9%, psychiatric trauma (66%, allergic substance (63.8%, the noise (36.2%, and physical abuse (23.4% were the risk factors they raced in working medium .In the health problem seen in the nurses, in the first row is lumbago. CONCLUSION: In the result of the study, it was found out that while practicing their professions, the nurses expressed that infection risk was the highest rate among the risk factors they raced in working medium and, in the health problem seen in the nurses, in the first row is lumbago and that the nurses and organizations’ attempts which will reduce the risks were not sufficient. [TAF Prev Med Bull 2009; 8(4.000: 339-344
de Assis, Wesley Dantas; Collet, Neusa; Reichert, Altamira Pereira da Silva; de Sá, Lenilde Duarte
This is a qualitative research, which purpose was to analyse the working process of nurse in child care actions in family health units. Nurses are the subjects and empirical data was achieved by the means of participant observation, and interviews. Data analysis followed thematic analysis fundaments. Results reveal that working process organization of nurses still remains centered in proceedings with an offert of assistance based in client illness, showing obstacles to puericulture practice in health basic attention.
Europe and reducing the number of military personnel by 40,000 to 60,000. According to United States Air Force General Charles Wald , there are...The Deputy Secretary of Defense Paul Wolfowitz is quoted as saying United States presence “…may be more political than actually military” and that
Smith, C A; Belles, R D; Simon, A J
Flow charts depicting water use in the United States have been constructed from publicly available data and estimates of water use patterns. Approximately 410,500 million gallons per day of water are managed throughout the United States for use in farming, power production, residential, commercial, and industrial applications. Water is obtained from four major resource classes: fresh surface-water, saline (ocean) surface-water, fresh groundwater and saline (brackish) groundwater. Water that is not consumed or evaporated during its use is returned to surface bodies of water. The flow patterns are represented in a compact 'visual atlas' of 52 state-level (all 50 states in addition to Puerto Rico and the Virgin Islands) and one national water flow chart representing a comprehensive systems view of national water resources, use, and disposition.
Manning, Vicki; Jones, Alan; Jones, Pamela; Fernandez, Ritin S
The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants' perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month follow-up surveys were observed in the participants' confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy.
Passos, Joanir Pereira; Ciosak, Suely Itsuko
This study is part of a larger survey called "Use of indicators in nurses' managerial practice in Basic Health Care Units in the city of Rio de Janeiro", which was carried out in the Basic Health Care Units of the Planning Area 5.3 and whose objectives were to identify nurses' conception regarding the tools required for management in those units and to discuss the role of management in organizing health services. The study is descriptive and data were collected in interviews with seven nurse managers. The results show that health services actions are organized and directed to the purpose of the working process through the relationship established between the object, the instruments and the final product, and that for those nurses the end result to be achieved is client's satisfaction and the quality of medical and nursing care.
Full Text Available The comprehensive nature of nurse training needs the involvement of almost all health team personnel, including unit managers to gain practical experience and learn to correlate theory and practice. The overall aim of the study was to explore and describe the experiences of unit managers regarding teaching of student nurses in the clinical area and to develop recommendations that will enhance clinical teaching, for the production of competent future nurse practitioners who will render quality care to patients. A qualitative design, which is explorative, descriptive and contextual in nature, was employed, utilizing a phenomenological approach to capture the experiences of unit managers regarding teaching of student nurses at selected hospitals, where students are allocated for their clinical exposure. Ethical measures as well as measures to ensure trustworthiness were adhered to. In-depth phenomenological interviews were conducted with unit managers who shared their experiences regarding clinical teaching of student nurses. Data analysis was done according to Tesch’s (1990 open coding method. One major theme emerged, namely that unit managers experienced problems when doing clinical teaching of student nurses. Based on the findings the following recommendations were made: Colleges should open a two-way communication with unit managers, involvement of unit managers in the activities that take place at the college like courses, seminars and workshops on clinical teaching, learning contracts should be developed for the students and issues of clinical learning should be addressed and unit managers should be included in both summative and formative evaluations.
Pierskalla, W P; Woods, D
This article discusses the current state of informations systems in hospital management. Decision Support Systems (DSS) for the management, administrative and patient care units of the hospital are described. These DSS's include market planning, nurse scheduling and blood screening systems. Trends for future uses of information systems in the hospital environment are addressed.
states of North Africa and the Middle East.5 Eurabia was the name of a journal published in the mid-1970s by the European Committee for...have her extradited to Switzerland so she could be prosecuted under Swiss anti- racism statute, Islamic groups successfully prevailed to have her...options. The United States can forge new relationships with emerging powers such as Brazil, Russia, India and China, the so called BRIC countries
In December 2013, the first cases of the most recent outbreak of Ebola virus disease (formerly known as Ebola hemorrhagic fever) emerged in the West African nation of Guinea. Within months the disease had spread to the neighboring countries of Liberia and Sierra Leone. The international humanitarian aid organization Médecins Sans Frontières (MSF; known in English as Doctors Without Borders) soon responded by sending staff to set up treatment centers and outreach triage teams in all three countries. In August 2014, the World Health Organization declared the outbreak an international public health emergency.In September 2014, the author was sent by MSF to work as a nurse in an Ebola treatment unit in Liberia for five weeks. This article describes her experiences there. It provides some background, outlines the practices and teams involved, and aims to convey a sense of what it's like to work during an Ebola outbreak and to put a human face on this devastating epidemic.
Tochterman, Lori A.
The Dedicated Education Unit (DEU) is a model of clinical teaching which has gained widespread acceptance and national recognition as an innovative method of clinical education for undergraduate nursing students (Robert Wood Johnson Foundation, 2010; Warner & Burton, 2009). The primary goals and benefits of the DEU for schools of nursing are…
Brødsgaard, Anne; Larsen, Palle; Weis, Janne
REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify how parents of premature infants in neonatal intensive care units (NICUs) and nurses perceive their partnership.The review questions are: how do parents of premature infants and nurses perceive their partnership during hospita...
Benton, David C; Ferguson, Stephanie L
Windows of opportunity are wide open for the nursing profession to actively participate and engage in the policy implementation, evaluation, and achievement of the United Nations Sustainable Development Goals. Nurses bring valuable perspectives as members of diverse governance structures and offer a range of solutions that can help governments pursue and achieve the Sustainable Development Goals and targets by 2030.
Eggenberger, Sandra K; Sanders, Marita
The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses' attitudes towards and confidence in providing family care, as well as families' perceptions of support from nurses in an adult critical care setting. An academic-clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members' experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic-clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in
In 1937,Zhang Ying studied at the Lu Xun Art Institute in Yan’an.After graduation she began working in the art world under Zhou Enlai’s direction.In 1983, she followed her husband Zhang Wenjin to the United States as wife of the ambassador.During her two-year stay in the U.S., she came into close contact with many American women while working to promote mutual understanding and friendship between the people of the two countries.After her retirement in 1991,she sponsored the production of a 10-episode documentary TV program,"Zhou Enlai and the Arts."She also wrote a book about her experience in the United States,Called,Following Zhang Wenjin to the United States—Notes of an Ambassador’s Wife.The following are extracts from the book.
This report discusses the management and security of nuclear weapons in the post-cold war United States. The definition of what constitutes security is clearly changing in the US. It is now a much more integrated view that includes defense and the economy. The author tries to bring some semblance of order to these themes in this brief adaptation of a presentation.
Multilocus DNA sequence data was used to retrospectively assess the genetic diversity and evolutionary relationships of 67 Fusarium strains from veterinary sources, most of which were from the United States. Molecular phylogenetic analyses revealed that the strains comprised 23 phylogenetically dist...
Robbins, W. H.; Donoughe, P. L.
The results are presented of the United States experiments activity to date. Wide segments of the population are involved in the Experiments Program including the scientific community, other government agencies, industry, and the education and health entities. The experiments are associated with both technological objectives and the demonstration of new community and social services via satellite.
National Center for Health Statistics (DHEW/PHS), Hyattsville, MD.
Presented are prevalence data on color vision deficiencies (color blindness) in noninstitutionalized children, aged 6-11, in the United States, as estimated from the Health Examination Survey findings on a representative sample of over 7,400 children. Described are the two color vision tests used in the survey, the Ishihara Test for Color…
Smith, Maureen A.; Seplaki, Christopher; Biagtan, Mark; DuPreez, Amanda; Cleary, James
Purpose: Although caregivers desire specific information about hospice programs, there is little descriptive information available. We characterized agencies that provide formal or informal hospice care in the United States according to four types of services considered important by caregivers: medications and treatments; rehabilitative care;…
gains and losses NRV = Net Realizable Value O = Other Inventory, Gross Value Revaluation Allowance Inventory, Net 2002 2001 United States Air Force...losses NRV = Net Realizable Value O = Other For the most part, DMAG is using the consumption method of accounting for OM&S, since OM&S is defined in the
U.S. Geological Survey, Department of the Interior — This map layer shows major ports in the United States, Puerto Rico, and the U.S. Virgin Islands. A port is a city, town, or urban area with a harbor where ships load...
... and Programs Resource Center Viral Hepatitis Surveillance for Viral Hepatitis â€“ United States, 2014 Recommend on Facebook Tweet Share ... Cases Hepatitis A Hepatitis B Hepatitis C Discussion Hepatitis A virus Index PAGE DESCRIPTION Table 2.1 Reported ...
U.S. Geological Survey, Department of the Interior — This is a polygon coverage of major land uses in the United States. The source of the coverage is the map of major land uses in the National Atlas, pages 158-159,...
34 Rheinischer Merkur (Bonn), January 17, 1992, 5. 17. Robert J. Samuelson, "Europe’s Boom Has Come and Cone," Washington Post, February 12, 1992, A23...34 Rheinischer Merkur (Bonn), January 17, 1992, 5. Riemer, Blanca. "’United States of Europe’? Don’t Hold Your Breath." Business Week, June 17, 1991, 50
U.S. Geological Survey, Department of the Interior — This map layer includes airports in the United States, Puerto Rico and the U.S. Virgin Islands. The data were derived from an extract of the Public-Use Airports...
Erickson, Amy H.; Melendez, Barbra S.; Ball, Daniel L.; Morse, Steven T.; Phillips, Geoffrey P.
This project is one of four that were issued to first semester sophomore undergraduates at the United States Military Academy as part of an integrated learning experience at the end of their Calculus II course work. This project was used during a short, seven lesson block of instruction that was intended to capitalize on their recent academic…
Jeffery, Charles F.
The history of orienteering in the United States includes both military and civilian interest, with the period of greatest growth between 1970 and 1980. To investigate growth patterns in orienteering, questionnaires were mailed to 42 civilian orienteering clubs and 286 universities supporting senior Reserve Office Training Corps (ROTC)…
... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 539.312 Section 539.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY WEAPONS OF MASS DESTRUCTION TRADE CONTROL...
... Videos Blog Get Involved Shop Ask a question right here... MHAUS On Facebook Now view more On Twitter Now view more Tweets by @ ... Malignant Hyperthermia Association of the United States. All rights reserved. ... advertiser and not necessarily the views or opinions of MHAUS, its staff or its ...
almost totally unproductive ceremony and haggling with the Cochinchinese authorities. During his stay there, White developed an appreciation of the...British and French involvement with the warring sides in the United States and with French adventures in Mexico , not with events in far-off
Sarah McCaffrey; Eric Toman; Melanie Stidham; Bruce. Shindler
The rising number of acres burned annually and growing number of people living in or adjacent to fire-prone areas in the United States make wildfire management an increasingly complex and challenging problem. Given the prominence of social issues in shaping the current challenges and determining paths forward, it will be important to have an accurate understanding of...
Carter, Julie H.
As citizens of the United States respond to legislative and judicial actions that have challenged the prohibition against same-sex couples receiving marriage licenses, schools have a timely opportunity to engage students on this most important debate. Educators can help their students understand the full significance of this issue by encouraging…
U.S. Geological Survey, Department of the Interior — A digital version of the Geologic Map of the United States, originally published at a scale of 1:2,500,000 (King and Beikman, 1974b). It excludes Alaska and Hawaii.
Wall, Jaimie N; Shackelford, Todd K
Fincher & Thornhill (F&T) present a powerful case for the relationship between parasite-stress and religiosity. We argue, however, that the United States may be more religious than can be accounted for by parasite-stress. This greater religiosity might be attributable to greater sensitivity to immigration, which may hyperactivate evolved mechanisms that motivate avoidance of potential carriers of novel parasites.
Lont, Cynthia M.
The purpose of this presentation was to: (1) describe the history of women's music in the United States; (2) define women's music; (3) report on the status of the large women's recording companies; and (4) focus on a recent controversy in the women's music industry involving the desire for political purity versus the need for economic security.…
Dr. Amesh Adalja, an associate at the Center for Biosecurity and clinical assistant professor at the University of Pittsburgh School, of Medicine, discusses dengue fever outbreaks in the United States. Created: 4/9/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Date Released: 4/16/2012.
Kurt H. Riitters; John W. Coulston
Fragmentation is a continuing threat to the sustainability of forests in the Eastern United States, where land use changes supporting a growing human population are the primary driver of forest fragmentation (Stein and others 2009). While once mostly forested, approximately 40 percent of the original forest area has been converted to other land uses, and most of the...
Piaget (1964) believed that interaction with the environment has a large part to play in human development. Matthew (1986) states that in an ideal world critically ill children should be cared for by staff trained in paediatrics, within designated paediatric intensive therapy units. Unfortunately, there are only 28 paediatric intensive therapy units in Great Britain (CMA Medical Data, 1987), consequently each year a third of children requiring intensive care are admitted to adult intensive therapy units (ITU). A knowledge and understanding of developmental psychology can therefore be beneficial to nurses in assessing which stage of development a child has reached, in order to plan the correct level of stimulation, and hence facilitate progress rather than regression in the accomplishment of developmental tasks. The psychological and social processes involved in Jean Piaget's (1896-1980) theory of human development are discussed with regard to nursing children requiring intubation and ventilation in an adult ITU.
<正>From April 13 to 21, a CPAFFC working group led by Yao Mingyu, director general of the Department of American and Oceanian Affairs of the CPAFFC, visited the United States, attended the 18th Forum on US-China Relations sponsored by the US-China Peoples Friendship Association (USCPFA) and had talks with the USCPFA, the Richard Nixon Library & Birthplace Foundation, the Richard Nixon Centre, the Sister Cities International of the U.S., the National Conference of State Legislatures, the Council of State
Full Text Available The aim of this descriptive study is to identify the ego states in the Transactional Analysis Approach for evaluating the interpersonal communication process, as well as the views of the nursing students regarding the democratic attitudes of their instructors. Consequently, the faculty members had democratic attitudes and there was a very high direct correlation between the Nurturing Parent ego state and democratic attitude.
Full Text Available Workplace violence is present in many work sectors, but in the area of mental health, nurses have a higher risk due to the close relationship they have with users. This study analyzed hostile user statements against nursing professionals of Mental Health Services and Emergency Units in Health Service (MHS hospitals in Murcia, Spain, and determined the frequency of exposure to the different violent user behaviors. The study was carried out with a sample of 518 nursing professionals from four hospital services: Mental Health, Emergency Units, Medical Hospitalization, and Maternal-and-Child. The nursing staff of Mental Health and Emergency Units was the most exposed to violence. Non-physical violence was more frequent in Emergency Units, whereas physical violence was more frequent in Mental Health. Among the consequences of exposure to non-physical violence are workers’ emotional exhaustion and the presence of psychological distress.
Robbins, B T
The nursing profession is moving toward developing a standardized language. Benefits of such a language are outlined. Nursing Interventions Classification (NIC) (Iowa Intervention Project, 1992), a standardized language for nursing interventions, has been recently developed by the Iowa Intervention Project. This article describes how NIC was incorporated into a nursing care plan in a tertiary acute care facility. Teaching strategies, which include aspects of adult learning theory and motivational theory, are discussed. Utilization of creativity and variability in the planning and implementation of a unit based inservice program were the most beneficial strategies used.
Nauderer, Taís Maria; Lima, Maria Alice Dias da Silva
On Public Health, nurses can influence the care of the health needs of the population. The objective of this paper is to feature and understand the practices of nurses working at Health Basic Units. It is a qualitative research whereby semi-structured interviews were made with 15 nurses who work at Porto Alegre-Brasil. The treatment of the data was based on analysis of content of the thematic type. Outcomes indicate that the activities performed by nurses are influenced by the Hea...
... AFFAIRS Agency Information Collection (Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring and Retaining Nurses at State Homes) Activities Under OMB Review AGENCY....'' SUPPLEMENTARY INFORMATION: Title: Regulation on Reduction of Nursing Shortages in State Homes; Application for...
Tye, C C; Ross, F.; Kerry, S. M.
OBJECTIVE: To establish the current and predicted distribution of formal emergency nurse practitioner services in major accident and emergency departments in the United Kingdom; to determine organisational variations in service provision, with specific reference to funding, role configuration, training, and scope of clinical activity. METHODS: Postal survey of senior nurses of all major accident and emergency departments in the United Kingdom (n = 293) in May/June 1996. RESULTS: There were 27...
W.J.C. Van Rhyn
Full Text Available An exploratory study was conducted with the aim of discovering and describing experiences of psychiatric nursing students during clinical placement in a psychiatric unit. For the purpose of the study an unstructured interview was conducted with each participant during their first placement in a psychiatric unit to identify the factors experienced as stressful. The results indicated that all eight participants experienced average to high stress. Sources of stress identified included, among others, ineffective teaching and learning programmes, poor managerial governance of the service, detachment of professional nurses from their teaching role, poor relationships among staff, overreliance on the medical model of care and patient neglect. Psychiatric nursing students sampled indicated universal support for in-service education and training for professional nurses, attitude change of professional nurses towards students, support for student initiatives, student involvement in patient care and adequate allocation of resources for patient care and nurse training. The exploration and description of experiences of the psychiatric nursing students will help nurse educators plan clinical learning opportunities in such a way that they are less stressful, thus ensuring that psychiatric nursing students are equipped to utilise themselves as therapeutic instruments.
Russo, Jennefer A; Schumacher, Kristin L; Creinin, Mitchell D
This study was conducted to determine if an association exists between the amount of harassment and violence directed against abortion providers and the restrictiveness of state laws relating to family planning. We used responses from a July 2010 survey of 357 abortion providers in 50 states to determine their experience of antiabortion harassment and violence. Their responses were grouped and analyzed in relation to a published grading of state laws in the United States (A, B, C, D and F) as they relate to restrictions on family planning services. Group by group comparison of respondents illustrates that the difference in the number of reported incidents of minor vandalism by group is statistically significant (A vs. C, p=.07; A vs. D, p=.017; A vs. F, p=.0002). Incidents of harassment follow a similar pattern. There were no differences noted overall for violence or major vandalism. Major violence, including eight murders, is a new occurrence in the last two decades. Harassment of abortion providers in the United States has an association with the restrictiveness of state abortion laws. In the last two decades, murder of abortion providers has become an unfortunate part of the violence. Copyright © 2012 Elsevier Inc. All rights reserved.
Yönt, Gülendam Hakverdioğlu; Korhan, Esra Akin; Dizer, Berna; Gümüş, Fatma; Koyuncu, Rukiye
Nurses are more likely to face the dilemma of whether to resort to physical restraints or not and have a hard time making that decision. This is a descriptive study. A total of 55 nurses participated in the research. For data collection, a question form developed by researchers to determine perceptions of ethical dilemmas by nurses in the application of physical restraint was used. A descriptive analysis was made by calculating the mean, standard deviation, and maximum and minimum values. The nurses expressed (36.4%) having difficulty in deciding to use physical restraint. Nurses reported that they experience ethical dilemmas mainly in relation to the ethic principles of nonmaleficence, beneficence, and convenience. We have concluded that majority of nurses working in critical care units apply physical restraint to patients, although they are facing ethical dilemmas concerning harm and benefit principles during the application.
Amante, Lúcia Nazareth; Rossetto, Annelise Paula; Schneider, Dulcinéia Ghizoni
The purpose of this study was to implement the Nursing Care Systematization--Sistematização da Assistência de Enfermagem (SAE)--with Wanda Aguiar Horta's Theory of Basic Human Necessities and the North American Nursing Diagnosis Association's (NANDA) Nursing Diagnosis as its references. The starting point was the evaluation of the knowledge of the nursing team about the SAE, including their participation in this process. This is a qualitative study, performed in the Intensive Care Unit in a hospital in the city of Brusque, Santa Catarina, from October, 2006 to March, 2007. It was observed that the nursing professionals know little about SAE, but they are greatly interested in learning and developing it in their daily practice. In conclusion, it was possible to execute the healthcare systematization in an easy way, with the use of simple brochures that provided all the necessary information for the qualified development of nursing care.
Daniela Couto Carvalho Barra
Full Text Available OBJECTIVE To analyze the usability of Computerized Nursing Process (CNP from the ICNP® 1.0 in Intensive Care Units in accordance with the criteria established by the standards of the International Organization for Standardization and the Brazilian Association of Technical Standards of systems. METHOD This is a before-and-after semi-experimental quantitative study, with a sample of 34 participants (nurses, professors and systems programmers, carried out in three Intensive Care Units. RESULTS The evaluated criteria (use, content and interface showed that CNP has usability criteria, as it integrates a logical data structure, clinical assessment, diagnostics and nursing interventions. CONCLUSION The CNP is a source of information and knowledge that provide nurses with new ways of learning in intensive care, for it is a place that provides complete, comprehensive, and detailed content, supported by current and relevant data and scientific research information for Nursing practices.
Paula Pedroso Peninck
Full Text Available Sepsis is defined as a clinical syndrome consisting of a systemic inflammatory response associated to an infection, which may determine malfunction or failure of multiple organs. This research aims to verify the application of implementation of sepsis algorithm by nurses in the Intensive Care Unit and create an operational nursing assistance guide. This is an exploratory, descriptive study with quantitative approach. A data collection instrument based on relevant literature was elaborated, assessed, corrected and validated. The sample consisted of 20 intensive care unit nurses. We obtained satisfactory evaluations on nurses’ performance, but some issues did not reach 50% accuracy. We emphasize the importance of greater numbers of nurses getting acquainted and correctly applying the sepsis algorithm. Based on the above, an operational septic patient nursing assistance guide was created, based on the difficulties that arose vis-à-vis the variables applied in research and relevant literature.
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... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY United States Mint Pricing for Certain United States Mint Products AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of...
... Internal Revenue Service 26 CFR Part 1 RIN 1545-BK11 Modifications to Definition of United States Property... or clearing agency do not constitute United States property. These regulations affect United States...)) that invests certain earnings and profits in United States property (U.S. property) ``on the...
Farahani, Mansoureh A; Gaeeni, Mina; Mohammadi, Nooreddin; Seyedfatemi, Naima
Receiving information related to patients hospitalized in the intensive care unit is among the most important needs of the family members of such patients. When health care professionals should decide whether to be honest or to give hope, giving information becomes an ethical challenge We conducted a research to study the ethical approaches of Iranian nurses to giving information to the family members of patients in the intensive care units. This research was conducted in the intensive care units of three teaching hospitals in Iran. It employed a qualitative approach involving semi-structured and in-depth interviews with a purposive sample of 12 nurses to identify the ethical approaches to giving information to family members of the intensive care unit patients. A conventional content analysis of the data produced two categories and five subcategories. The two categories were as follows: a) informational support, and b) emotional support. Informational support had 2 subcategories consisting of being honest in giving information, and providing complete and understandable information. Emotional support in giving information had 3 sub-categories consisting of gradual revelation, empathy and assurance. Findings of the study indicated that ethical approaches to giving information can be in the form of either informational support or emotional support, based on patients' conditions and prognoses, their families' emotional state, the necessity of providing a calm atmosphere in the ICU and the hospital, and other patients and their families' peace. Findings of the present study can be used as a basis for further studies and for offering ethical guidelines in giving information to the families of patients hospitalized in the ICU.
The Roles and Functions of Occupational Health Nurses in Brazil and in the United States Los papeles y funciones del enfermero de salud laboral en Brasil y en los Estados Unidos de America Atribuições e funções dos enfermeiros do trabalho no Brasil e nos Estados Unidos
Maria Helena Palucci Marziale
Full Text Available Cross-sectional exploratory research developed to outline the roles and functions of occupational health nurses (OHNs in Brazil and compare them with those in the United States. The sample consisted of 154 Brazilian occupational health nurses. First, the instrument Job Analysis Survey of Occupational Health Nursing Practice was translated into Portuguese, followed by data collection and data analysis, comparing the results of the proposed study in Brazil with the findings of a job delineation study conducted in the United States. It was found that most were women, white, between 41 and 50 years of age and working primarily at hospitals or medical centers as clinicians and managers/administrators. Besides, it was found that most Brazilian OHNs spend more time in managerial roles, followed by consultant and educator responsibilities while, in the United States, OHNs spend significantly more time in education/advisory roles.Investigación transversal realizada con el objetivo de definir los papeles y funciones de los enfermeros de salud laboral (ESLs en Brasil y compararles con los de los Estados Unidos de América (EUA. La muestra fue compuesta por ciento cincuenta y cuatro enfermeros de salud laboral brasileños. Primero, fue realizada la traducción de lo instrumento Job Analysis Survey of Occupational Health Nursing Practice para el Portugués, seguido de la recolecta y análisis de los datos, comparándolos con los hallazgos de un estudio conducido en los EUA. Se encontró que la mayoría eran mujeres, blancas, entre 41 y 50 años e trabajan en hospitales y centros médicos como enfermeros clínicos y administradores. También se encontró que ESLs brasileños dedican más tiempo en funciones administrativas, seguidas de responsabilidades de consultoría y educador, mientras en los EUA los ESLs dedican significativamente más tiempo en funciones educativas y de asesoría.Estudo transversal desenvolvido com o objetivo de delinear as
This study analyzed factors in attracting and recruiting professional nurses into Massachusetts state service. Although Massachusetts had relatively many registered nurses (RN), 45% were inactive. Resulting shortages were great, especially in state hospitals. All agencies had high turnover, with impending staffing crises in some agencies because…
Desjardins, France; Cardinal, Linda; Belzile, Eric; McCusker, Jane
A time-and-motion study was conducted in response to perceptions that the surgical nursing staff at a Montreal hospital was spending an excessive amount of time on non-nursing care. A sample of 30 nurse shifts was observed by trained observers who timed nurses' activities for their entire working shift using a hand-held Personal Digital Assistant. Activities were grouped into four main categories: direct patient care, indirect patient care, non-nursing and personal activities. Break and meal times were excluded from the denominator of total worked hours. A total of 201 working hours were observed, an average of 6 hours, 42 minutes per nurse shift. The mean proportions of each nurse shift spent on the main activity categories were: direct care 32.8%, indirect care 55.7%, non-nursing tasks 9.0% and personal 2.5%. Three activities (communication among health professionals, medication verification/preparation and documentation) comprised 78.9% of indirect care time. Greater time on indirect care was associated with work on night shifts and on the short-stay surgical unit. Subsequent work reorganization focused on reducing time spent on communication and medications. The authors conclude that time-and-motion studies are a useful method of monitoring appropriate use of nursing staff, and may provide results that assist in restructuring nursing tasks.
Sidumo, E M; Ehlers, V J; Hattingh, S P
Culture defines how persons behave towards each other. When nurses and patients belong to different cultures, culture-based misunderstandings could influence the nurse-patient relationships and interactions adversely. The purpose of the study was to determine non-Muslim nurses' knowledge about Muslim traditions pertaining to obstetric units in a Muslim country. A quantitative descriptive research design was adopted. The population comprised 67 nurses, but the accessible population consisted of 52 nurses who were working in the participating hospital's gynaecological wards during the data collection phase. However, only 50 nurses completed questionnaires as two nurses did not want to participate in the study. The Statistical Package for the Social Sciences (SPSS Version 11.5) was used to analyse the data. The research results indicate that non-Muslim nurses lacked knowledge about Muslim practices concerning breastfeeding, Ko'hl, the "evil eye", modesty, medicine and food taboos. If these aspects could be addressed during the recruitment and in-service education of non-Muslim nurses working in Muslim countries, this could enhance the quality of culture-competent nursing care.
Standards for nurse staffing in critical care units determined by: The British Association of Critical Care Nurses, The Critical Care Networks National Nurse Leads, Royal College of Nursing Critical Care and In-flight Forum.
Bray, Kate; Wren, Ian; Baldwin, Andrea; St Ledger, Una; Gibson, Vanessa; Goodman, Sheila; Walsh, Dominic
Since 1967 the gold standard for nurse staffing levels in intensive care and subsequently critical care units has been one nurse for each patient. However, critical care has changed substantially since that time and in recent years this standard has been challenged. Previously individual nursing organisations such as the British Association of Critical Care Nurses (BACCN) and the Royal College of Nursing have produced guidance on staffing levels for critical care units. This paper represents the first time all three UK Professional Critical Care Associations have collaborated to produce standards for nurse staffing in critical care units. These standards have evolved from previous works and are endorsed by BACCN, Critical Care Networks National Nurse Leads Group (CC3N) and the Royal College of Nursing Critical Care and In-flight Forum. The aim of this paper is to provide an overview of the much more detailed document 'Standards for Nurse Staffing in Critical Care', which can be found on the BACCN web site at www.baccn.org.uk. The full paper has extensively reviewed the evidence, whereas this short paper provides essential detail and the 12 standard statements. Representation was sort from each of the critical care associations. The authors extensively reviewed the literature using the terms: (1) critical care nursing, (2) nursing, (3) nurse staffing, (4) skill mix, (5) adverse events, (6) health care assistants and critical care, (7) length of stay, (8) critical care, (9) intensive care, (10) technology, (11) infection control. Comprehensive review of the evidence has culminated in 12 standard statements endorsed by BACCN, CC3N and the Royal College of Nursing Critical Care and In-flight Forum. The standards act as a reference for nursing staff, managers and commissioners associated with critical care to provide and support safe patient care. The review of the evidence has shown that the contribution of nursing can be difficult to measure and consequently support
Full Text Available Introduction. The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. Aim. The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? Material and Methods. The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation and 3.697 time-schedule measurements were carried out. Results. The total nursing time was 4125.79 min. (68.76 hours, that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ2=16945.8, P<0.001 between the nurses’ workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. Conclusions. The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs.
Kabler, Brenda; Weinstein, Elana
Across America, the numbers of homeless children and families are growing as a result of many factors including the recent economic crisis, home foreclosures, and natural disasters. Because of an increase in the number of homeless children throughout the United States, this population has unmet needs that can be targeted in school settings under…
E. M. Willis
Full Text Available Over the last two decades the flow of Asians to Australia through legitimate immigration programs has accelerated. This is particularly the case for Asian nurses coming from countries that were once subjected to European colonisation. The difficulties encountered by nurses from Asian countries mirror those of earlier waves of migrants. These include navigating the language and differences in cultural mores, values, and beliefs, along with the loneliness that may come from leaving strong family ties at home. While racism has been evident for all earlier waves of migrants, Asians face an additional hurdle linked to the uneasy relationship Australians and the Australian state has with Asia. Australia is geographically in Asia, but culturally Anglo and European. The impact this might have on the working relationships of Asian and Australian born registered nurses is significant given the nature of their work in caring for the sick and elderly. This liminal relationship between the Australian state and Asians provides a theoretical insight into the particular difficulties experienced by Asian nurses and the integration programs that might assist them and their Australian colleagues to develop cohesive working relationships.
The author identifies two factors contributing to the increase in the number of illegal migrant workers in the United States. The first is the complex system of legal immigration, which contributes to massive evasion. The second is the preference by many employers for hiring illegal aliens. The author concludes that the proposed changes in U.S. immigration laws, even though they include employer sanctions, are likely to prove as ineffective as previous measures adopted in several states some 10 years ago that also penalized employers hiring illegal aliens. It is suggested that the economic pressures leading to large-scale labor immigration will prove stronger than political pressures to control such immigration
Rochefort, Christian M; Clarke, Sean P
This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses' perceptions of care rationing, job outcomes, and quality of care. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Over a 6-month period in 2007-2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). A total of 339 nurses (61.3%) completed questionnaires. Overall, 18.6% were dissatisfied with their job, 35.7% showed high emotional exhaustion, and 19.2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units. © 2010 Blackwell Publishing Ltd.
C. Kenneth Tanner; Deborah Jan Vaughn Linscott; Susan Allan Galis
School reform issues addressing inclusive education were investigated in this nationwide (United States) study. A total of 714 randomly selected middle school principals and teachers responded to concerns about inclusion, "degree of change needed in" and "importance of" collaborative strategies of teaching, perceived barriers to inclusion, and supportive activities and concepts for inclusive education. There was disagreement among teachers and principals regarding some aspects of inclusive ed...
incidence of drug-resistant Streptococcus pneumoniae (DRSP) strains in the United States has created an emerging public health challenge. CDC...only 1,280 cases of Legionnaires’ disease were reported through NNDSS in 1993, data from recent prospective pneumonia studies suggest that between...surveillance data from 1992 indicated that the prevalence of pneumococcal strains that are highly resistant to penicillin increased 60-fold (from 0.02% to 1.3
stated that, "The wave of the future will be putting together task forces that will be able to respond to crisis management or humanitarian...examine three options for the military’s role in humanitaria operations at home and abroad. Option 1: Virtually Eliminate Anv Military Role This is the...humanitarian aid in almost any crisis .36 The military resists the creation of specially designated units because such specialization reduces the
increase the domestic price of those 41. Coal gasification is a process that converts solid coal—through several energy-intensive steps—into gasoline and...for switching to other fuels or reducing consumption of transportation fuels . In con- trast, electricity can be produced from several sources of...the prices of those fuels in the United States. Although the global nature of the market for oil makes U.S. consumers vulnerable to price
This view shows the west coast of the United States and Mexico (32.5N, 118.0W) and gives an indication of the range of view from orbital altitude. The visual range of this particular scene is from Skammon's Lagoon on Baja to the northern tip of California's Central Valley and Sierra Nevada, a range of over 15 degrees of latitude. Coastal fog drapes over southern California and northern Baja California. White Sands, New Mexico is at far right center.
standards. 3. Work with the privatized housing partner to ensure that fire protection inspection and maintenance plans are achieved. Deputy Assistant...Secretary stated that Hunt Military Communities and Patrick AFB civil engineers were working to correct all of the other fire protection system...create a plan for the performance of ongoing inspection and maintenance of all housing units to applicable electrical codes and standards. 3. Work
center between the United States and the Soviet Union. The method chosen to examine this trend is to review three major politico-military problems...de France, pp. 3-7. ൫ Supra-nationalism must go! De Gaulle’s heir presumptive, Georges Pompidou , has given voice to de Gaulle’s thoughts on... Pompidou said: Certainly we do not believe in integration as a method of approach to European unity, precisely because we believe that there can be no
This book presents OECD assessments and recommendations regarding the United States' efforts to manage its environment including air, water, nature, and biodiversity; to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 47 figs., 20 tabs.
Bischoff, Karyn; Smith, Mary C
This article lists commonly encountered toxic plants that affect ruminants in the Northeastern United States. Livestock are at risk for ingestion of a large variety of toxic plants. Plant poisonings are likely to be underdiagnosed because tests for most plant toxins are not routinely available at veterinary diagnostic laboratories. Prevention of access to poisonous plants is usually more effective and economical than treatment of plant poisonings. Copyright © 2011 Elsevier Inc. All rights reserved.
Cho, Ok-Hee; Yoo, Yang-Sook; Yun, Sun-Hee; Hwang, Kyung-Hye
To develop and validate an eye care educational programme for intensive care unit nurses. Eye care guidelines and protocols have been developed for increasing eye care implementation in intensive care units. However, the guidelines lack consistency in assessment or intervention methodology. This was a one-sample pre/postprogramme evaluation study design for testing the effects of the eye care educational programme, developed for and applied to intensive care unit nurses, on their levels of knowledge and awareness. The eye care educational programme was developed based on literature review and survey of educational needs. Thirty intensive care unit nurses served as subjects for the study. The levels of eye care-related knowledge, awareness and practice were enhanced following the implementation of the educational programme. Moreover, satisfaction with the educational programme was high. It is necessary to intensify eye care education aimed at new nurses who are inexperienced in intensive care unit nursing and provide continuing education on the latest eye care methods and information to experienced nurses. The eye care educational programme developed in this study can be used as a strategy to periodically assess the eye status of patients and facilitate the appropriate eye care. © 2016 John Wiley & Sons Ltd.
Moral distress is defined as knowing the right thing to do when policy constraints do not allow for appropriate choices. The purpose of the current study was to explore the existence of moral distress in oncology nurses with a cross-sectional survey completed by nurses working on inpatient units at a midwestern cancer hospital. Investigators distributed the Moral Distress Scale-Revised to all direct care staff nurses. The main research variables were moral distress, level of education, age, and type of unit. Most of the 73 nurses had low to moderate scores, and two had high scores. No significant correlations were observed among age or years of experience. Type of unit and level of moral distress were correlated, and an inverse relationship between level of education and moral distress was found. Moral distress exists in nurses who work on oncology units irrespective of experience in oncology or the specific unit. Nurses must be aware of the existence of moral distress and finds ways to reduce potential emotional problems.
In accordance with the Southern States Energy Board (SSEB) proposal, as incorporated into NETL/DE-FC26-97FT34199, the objective of this agreement is to streamline the environmental technology permitting process site-to-site, state-to-state, and industry-to-industry to achieve remediation and waste processing faster, better and cheaper. SSEB is working with member Governors, legislators and regulators to build consensus on streamlining the permitting process for new and innovative technologies for addressing the legacy of environmental problems from 50 years of weapons research, development and production. This report reviews mechanisms whereby industry consortiums and the Department of Energy (DOE) have been working with State regulators and other officials in technology deployment decisions within the DOE complex. The historic development of relationships with State regulators is reviewed and the current nature of the relationships examined. The report contains observations from internal DOE reviews as well as recommendations from the General Accounting Office (GAO) and other external organizations. The report discusses reorganization initiatives leading up to a DOE Top-to-Bottom review of the Environmental Management (EM) Program and highlights points of consideration for maintaining effective linkages with State regulators. It notes how the proposed changes will place new demands upon the National Energy Technology Laboratory (NETL) and how NETL can leverage its resources by refocusing existing EM efforts specifically to states that have DOE facilities within their borders (host-states). Finally, the report discusses how SSEB's Permitting Leadership in the United States (PLUS) program can provide the foundation for elements of NETL's technical assistance program that are delivered to regulators and other decision- makers in host-states. As a regional compact commission, SSEB provides important direct linkages to regulators and stakeholders who need
组织文化对一个组织起着导向、约束、凝聚、辐射以及激励作用.本文通过分析比较中美两国护理学专业认证组织在网站建设、行为规范、认证标准、认证程序、组织宗旨、实施方式等方面的异同,指出中国护理学专业认证组织需要建设良好的组织文化,体现其专业性和权威性,加强监督,把握好质性和量性指标,重视评估对高校的促进作用,明确组织目标,弘扬职业精神,从而促进护理学专业认证制度的完善.%Organizational culture played a role of guiding,restraining,cohesiving,radianting and encouraging in an organization.The aim of this study was to provide some references for the construction of organizational culture of nursing accreditation in China by comparing organizational culture of nursing accreditation between China and the United States.The comparative study was mainly used with literature review assisted.There were similarities and differences between website construction,behavioral norms,accreditation manual,accreditation procedures,mission,model of operation and so on.In order to set up healthy organizational culture of nursing accreditation,the profession and democracy of accreditation,surveillance system,relationship between the qualitative and quantitative criterions,evaluating procedure,definite organizational purpose and professional spirits should be paid more attention.
June, Kyung Ja; Cho, Sung-Hyun
To examine the relationship of low back pain prevalence and treatment to personal and work-related characteristics among intensive care unit nurses. Back pain is the most common work-related health problem among nurses. A cross-sectional study including a survey conducted in 2007. The study sample included 1345 nurses in 65 intensive care units in 22 South Korean hospitals. Back pain prevalence was measured by the frequency of back pain (always, once a week, once a month or once in two or more months) during the past year. Multilevel logistic regression analyses were conducted to examine the relationship between back pain and personal and work-related characteristics. The mean age of nurses was 27.2 years. Overall, 90.3% of nurses had back pain at least once a month (21.9% always, 40.7% once a week and 27.7% once a month). Only 18.3% had received medical treatment for their back pain. Compared with neonatal intensive care unit nurses, who had the lowest prevalence, nurses in other specialties, excluding paediatric intensive care units, had a greater likelihood of back pain. Specialty medical (e.g. cardiology, neurology) intensive care unit nurses had the greatest probability of back pain and treatment. Perceiving staffing as inadequate and working 6 or more night shifts per month were related to a 64% increase (OR = 1.64; 95% CI =1.16-2.33) and 48% increase (OR =1.48; 95% CI = 1.10-1.99) in back pain, respectively. Nurses with 2-4 years of working experience in intensive care units had the greatest probability of back pain and treatment. A high prevalence of back pain was found in intensive care unit nurses, even though they comprise a very young workforce in Korea. Improving nurse staffing, reducing the frequency of night shifts and assessing risk factors in specific intensive care unit specialties are suggested to decrease back pain prevalence. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.
Rincon, Teresa A; Manos, E LaVerne; Pierce, Janet D
The purpose of this article is to describe the usability and human factors engineering standards used in development of a sepsis alert known as the sepsis prompt. Sensory processing, cognitive processing, signal detection, criterion response, and user satisfaction were evaluated with controlled user testing and critical incident response techniques. Nurses reported that the sepsis prompt was visible and distinct, making it easily detectable. The prompt provided a clear response mechanism and adequately balanced the number of false alerts with the likelihood of misses. Designers were able to use a mental model approach as they designed the prompt because the nurses were already using a manual sepsis detection process. This may have predisposed the nurses to response bias, and as such, they were willing to accommodate more false alarms than nurses who are not familiar with sepsis screening (surveillance). Nurses not currently screening for sepsis may not place the same value on this alert and find it an annoyance. The sepsis prompt met usability standards, and the nurses reported that it improved efficiency over the manual screening method.
Nurses\\' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses\\' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients\\' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.
Robert C Holman
Full Text Available BACKGROUND: Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD, occurs worldwide. Variant CJD (vCJD, a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy. This study describes the occurrence and epidemiology of CJD and vCJD in the United States. METHODOLOGY/PRINCIPAL FINDINGS: Analysis of CJD and vCJD deaths using death certificates of US residents for 1979-2006, and those identified through other surveillance mechanisms during 1996-2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172-304 deaths. The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8% of the CJD deaths occurred among persons >or=65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%; the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively. Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States. CONCLUSION/SIGNIFICANCE: Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States.
Montserrat Martínez Lareo
Full Text Available The high costs of intensive care and the importance of patient safety and quality of care highlight the need to develop instrument to measure, as precisely as possible, nursing workload and staffing levels in intensive care. To assess the ideal staff number, we need instruments to measure the real nursing workload. The aim of this research is to compare two nursing workload measurement scales in Intensive Care Units, the Nursing Activities Score (NAS and Nine Equivalents of Nurse Manpower Use Score (NEMS. We also want to assess the staffing needs of our ICU. A descriptive correlational study will be performed in a mixed medical ICU. The sample will be composed of of a minimum of 70 patients. Data regarding individual patients and unit global workload will be recorded, measured both with the NEMS and NAS scales. The required nursing staff will be calculated according to the measured workload. Nursing staffing needs using both scales will be calculated and compared to the actual staff. A descriptive analysis of the variables will be performed, and the existing correlation between both scales will be assessed using the Pearson correlation coefficient. A Student-t test will be performed to determine the differences between the calculated staffing requirements and the actual nursing staff. All data analyses will be done using a statistical software.
Sobieralski, Joseph Bernard
General aviation in the United States has been an important part of the economy and American life. General aviation is defined as all flying excluding military and scheduled airline operations, and is utilized in many areas of our society. The majority of aircraft operations and airports in the United States are categorized as general aviation, and general aviation contributes more than one percent to the United States gross domestic product each year. Despite the many benefits of general aviation, the lead emissions from aviation gasoline consumption are of great concern. General aviation emits over half the lead emissions in the United States or over 630 tons in 2005. The other significant negative externality attributed to general aviation usage is aircraft accidents. General aviation accidents have caused over 8000 fatalities over the period 1994-2006. A recent Federal Aviation Administration proposed increase in the aviation gasoline tax from 19.4 to 70.1 cents per gallon has renewed interest in better understanding the implications of such a tax increase as well as the possible optimal rate of taxation. Few studies have examined aviation fuel elasticities and all have failed to study general aviation fuel elasticities. Chapter one fills that gap and examines the elasticity of aviation gasoline consumption in United States general aviation. Utilizing aggregate time series and dynamic panel data, the price and income elasticities of demand are estimated. The price elasticity of demand for aviation gasoline is estimated to range from -0.093 to -0.185 in the short-run and from -0.132 to -0.303 in the long-run. These results prove to be similar in magnitude to automobile gasoline elasticities and therefore tax policies could more closely mirror those of automobile tax policies. The second chapter examines the costs associated with general aviation accidents. Given the large number of general aviation operations as well as the large number of fatalities and
Jooste, Karien; Cairns, Lindi
This paper compares the perceptions of nurse managers and nurses about self-leadership of professional nurses while taking ownership of capacity building during unit management. The Nursing Strategy for South Africa states that the competency of nurses is dependent upon factors that lead to capacity building. A quantitative design was followed by conducting a survey. The target population included nurse managers and professional nurses working at an academic public hospital in the Gauteng Province of South Africa. The findings indicate shortcomings in relation to advising professional nurses about self-direction while taking ownership of their daily pressures and stresses associated with unit management. Professional nurses should develop their confidence by focusing on their self-leadership strengths when managing a unit. Recommendations are made to promote self-leadership while taking ownership of nurses during capacity building of unit management. © 2014 John Wiley & Sons Ltd.
Duffield, Christine; Roche, Michael; O'Brien-Pallas, Linda; Catling-Paull, Christine; King, Madeleine
Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated.
Hamlin, Amy S.
The United States is in the midst of an increasingly worsening shortage of registered nurses, due, in part, to the nursing educator shortage. Further, nursing programs nationwide are turning away qualified applicants because of a lack of nursing educators. Unfortunately, the nursing educator shortage is not a problem that will be easily fixed. As…
Mealer, Meredith; Conrad, David; Evans, John; Jooste, Karen; Solyntjes, Janet; Rothbaum, Barbara; Moss, Marc
The critical nursing shortage is particularly apparent in specialty areas such as intensive care units (ICUs). Some nurses develop resilient coping strategies and adapt to stressful work experiences, mitigating the development of common maladaptive psychological symptoms. To determine if a multimodal resilience training program for ICU nurses was feasible to perform and acceptable to the study participants. In a randomized and controlled 12-week intervention study, treatment and control groups completed demographic questions and measures of resilience, anxiety, depression, posttraumatic stress disorder (PTSD), and burnout syndrome before and after the intervention. The intervention included a 2-day educational workshop, written exposure sessions, event-triggered counseling sessions, mindfulness-based stress reduction exercises, and a protocolized aerobic exercise regimen. Nurses in the intervention arm also completed satisfaction surveys for each component of the intervention. This mulitmodal resilience training program was feasible to conduct and acceptable to ICU nurses. Both nurses randomized to the treatment group and nurses randomized to the control group showed a significant decrease in PTSD symptom score after the intervention. A multifaceted resilience training program for ICU nurses was both feasible and acceptable. A sufficiently powered, randomized clinical trial is needed to assess the effect of the intervention on improving individuals' level of resilience and improving psychological outcomes such as symptoms of anxiety, depression, burnout syndrome, and PTSD. ©2014 American Association of Critical-Care Nurses.
Full Text Available Culture defines how persons behave towards each other. When nurses and patients belong to different cultures, culture-based misunderstandings could influence the nurse-patient relationships and interactions adversely. The purpose of the study was to determine non-Muslim nurses’ knowledge about Muslim traditions pertaining to obstetric units in a Muslim country. A quantitative descriptive research design was adopted. The population comprised 67 nurses, but the accessible population consisted of 52 nurses who were working in the participating hospital’s gynaecological wards during the data collection phase. However, only 50 nurses completed questionnaires as two nurses did not want to participate in the study. The Statistical Package for the Social Sciences (SPSS Version 11.5 was used to analyse the data. The research results indicate that non-Muslim nurses lacked knowledge about Muslim practices concerning breastfeeding, Ko’hl, the “evil eye”, modesty, medicine and food taboos. If these aspects could be addressed during the recruitment and inservice education of non-Muslim nurses working in Muslim countries, this could enhance the quality of culture-competent nursing care.
E. M. Sidumo
Full Text Available Culture defines how persons behave towards each other. When nurses and patients belong to different cultures, culture-based misunderstandings could influence the nurse-patient relationships and interactions adversely. The purpose of the study was to determine non-Muslim nurses’ knowledge about Muslim traditions pertaining to obstetric units in a Muslim country. A quantitative descriptive research design was adopted. The population comprised 67 nurses, but the accessible population consisted of 52 nurses who were working in the participating hospital’s gynaecological wards during the data collection phase. However, only 50 nurses completed questionnaires as two nurses did not want to participate in the study. The Statistical Package for the Social Sciences (SPSS Version 11.5 was used to analyse the data. The research results indicate that non-Muslim nurses lacked knowledge about Muslim practices concerning breastfeeding, Ko’hl, the “evil eye”, modesty, medicine and food taboos. If these aspects could be addressed during the recruitment and inservice education of non-Muslim nurses working in Muslim countries, this could enhance the quality of culture-competent nursing care.
Nursing has always been viewed as a "women's profession" as evidenced by the fact that 97 percent of the 1.9 million registered nurses in the United States are female. The values of helping others, altruism, compassion, and sacrifice are associated with women and with nursing. However, because many young people today do not view these values as…
Dell, M A; Halpin, G
High school grade point averages, Scholastic Aptitude Test verbal and quantitative scores, and National League for Nursing Pre-Nursing Examination scores were obtained for 456 black students enrolled in a private baccalaureate school of nursing. Discriminant analysis showed that these measures significantly differentiated between dropouts and graduates. For 181 graduates, these same predictors plus college grade point average also significantly differentiated between passers and failers on the State Board Examination.
Helder, O.K.; Verweij, J.C.M.; Staa, A.L. van
To explore parents' and nurses' experiences with the transition of infants from the neonatal intensive care unit to a special care nursery. Qualitative explorative study in two phases. Level IIID neonatal intensive care unit in a university hospital and special care nurseries (level II) in five comm
J.C.M. Verweij; O.K. Helder; Dr. A.L. van Staa
To explore parents' and nurses' experiences with the transition of infants from the neonatal intensive care unit to a special care nursery. Qualitative explorative study in two phases. Level IIID neonatal intensive care unit in a university hospital and special care nurseries (level II) in five comm
Muths, E.; Adams, M.J.; Grant, E.H.C.; Miller, D.; Corn, P.S.; Ball, L.C.
More than 25 years ago, scientists began to identify unexplained declines in amphibian populations around the world. Much has been learned since then, but amphibian declines have not abated and the interactions among the various threats to amphibians are not clear. Amphibian decline is a problem of local, national, and international scope that can affect ecosystem function, biodiversity, and commerce. This fact sheet provides a snapshot of the state of the amphibians and introduces examples to illustrate the range of issues in the United States.
Polat, Sevinç; Parlak Gürol, Ayşe; Cevik, Umran
In five neonatal intensive care units (NICUs) in two cities, the hand hygiene applications of 72 nurses included in this observational study have been investigated. The research was conducted between February and June 2007. It was found that before entering the NICUs, majority of nurses have washed their hands but used much less alcohol-based antiseptics; more than half of the nurses did not use gloves, and 50 of them did not wash their hands before care and one-third of the nurses did not wash their hands after care after neonatal treatments. The results obtained from our research showed that most of the nurses paid more attention to hand washing before applying medical treatment.
Neves, Rinaldo de Souza
The utilization of a conceptual model in the Nursing Attendance Systemization allows the development of activities based on theoretical references that can guide the implantation and the implementation of nursing proceedings in hospitals. In this article we examine the option made for the implementation of the Horta's conceptual model in the construction of a nursing attendance system in the Rehabilitation Unit of a public hospital located in the Federal District of Brazil. Through the utilization of these theoretical references it was possible to make available a data collection tool based on the basic human needs. The identification of these needs made possible the construction of the hierarchically disposed pyramid of the neurological patients' modified basic needs. Through this reference paper we intend to elaborate the prescription and nursing evolution based in the concepts and standards of the Horta's nursing process, making possible the inter-relationship of all phases of this attendance methodology.
Ross, S J; Polsky, D; Sochalski, J
The United Kingdom and the United States are among several developed countries currently experiencing nursing shortages. While the USA has not yet implemented policies to encourage nurse immigration, nursing shortages will likely result in the growth of foreign nurse immigration to the USA. Understanding the factors that drive the migration of nurses is critical as the USA exerts more pull on the foreign nurse workforce. To predict the international migration of nurses to the UK using widely available data on country characteristics. The Nursing and Midwifery Council serves as the source of data on foreign nurse registrations in the UK between 1998 and 2002. We develop and test a regression model that predicts the number of foreign nurse registrants in the UK based on source country characteristics. We collect country-level data from sources such as the World Bank and the World Health Organization. The shortage of nurses in the UK has been accompanied by massive and disproportionate growth in the number of foreign nurses from poor countries. Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the UK. Poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labour. This tendency is currently exacerbated by nursing shortages in developed countries. Countries at risk for nurse emigration should adjust health sector planning to account for expected losses in personnel. Moreover, policy makers in host countries should address the impact of recruitment on source country health service delivery.
Ethical issues in the response to Ebola virus disease in United States emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine.
Venkat, Arvind; Asher, Shellie L; Wolf, Lisa; Geiderman, Joel M; Marco, Catherine A; McGreevy, Jolion; Derse, Arthur R; Otten, Edward J; Jesus, John E; Kreitzer, Natalie P; Escalante, Monica; Levine, Adam C
The 2014 outbreak of Ebola virus disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged U.S. emergency departments (EDs) to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to U.S. acute care facilities, ethical questions have been raised in both the press and medical literature as to how U.S. EDs, emergency physicians (EPs), emergency nurses, and other stakeholders in the health care system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to U.S. EPs, emergency nurses, and other stakeholders in the health care system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to U.S. EDs in how they approach preparation for and management of potential patients with EVD.
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Remittances in the United States. 22.3 Section...-DEPARTMENT OF STATE AND FOREIGN SERVICE § 22.3 Remittances in the United States. (a) Type of remittance. Remittances shall be in the form of: (1) Check or bank draft drawn on a bank in the United States; (2)...
Crippen, John R.; Bue, Conrad D.
Peak floodflows from thousands of observation sites within the conterminous United States were studied to provide a guide for estimating potential maximum floodflows. Data were selected from 883 sites with drainage areas of less than 10,000 square miles (25,900 square kilometers) and were grouped into regional sets. Outstanding floods for each region were plotted on graphs, and envelope curves were computed that offer reasonable limits for estimates of maximum floods. The curves indicate that floods may occur that are two to three times greater than those known for most streams.
The United States and Canada have been cooperating in all areas of energy exchange for many years. Electrical energy has been chosen to be the focus of this study because substantial means for exchanges offer benefits that have not yet been fully exploited. There may be some bilateral benefits from additional interconnections because of the buffers which they represent against domestic imbalances. After the history of the electricity exchanges between the two countries is reviewed, opportunities and incentives and obstacles and constraints are discussed in the next two chapters. The final chapter examines procedures to resolve obstacles and minimize constraints. (MCW)
stage over the last 6 years.7 The DoD is on the cutting edge of partnering and there have been valuable lessons learned at the tactical and...global stage . “3D are the three pillars that provide the foundation for promoting and protecting U.S. national security interests abroad.”33 DoD, DoS...operations now will mean throwing 18 away hard-fought gains, and expose the United States to new risks from across the globalising
This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.
Agnew, Carson E.; Bhagat, Jai; Hopper, Edwin A.; Kiesling, John D.; Exner, Michael L.; Melillo, Lawrence; Noreen, Gary K.; Parrott, Billy J.
Mobile satellite service (MSS) has been under development in the United States for more than two decades. The service will soon be provided on a commercial basis by a consortium of eight U.S. companies called the American Mobile Satellite Consortium (AMSC). AMSC will build a three-satellite MSS system that will offer superior performance, reliability and cost effectiveness for organizations requiring mobile communications across the U.S. The development and operation of MSS in North America is being coordinated with Telesat Canada and Mexico. AMSC expects NASA to provide launch services in exchange for capacity on the first AMSC satellite for MSAT-X activities and for government demonstrations.
Clifton, Andrew; Newman, Jennifer; St. Pe, Alexandra; Iungo, G. Valerio; Wharton, Sonia; Herges, Tommy; Filippelli, Matthew; Pontbriand, Philippe; Osler, Evan
IEA Wind Task 32 seeks to identify and mitigate the barriers to the adoption of lidar for wind energy applications. This work is partly achieved by sharing experience across researchers and practitioners in the United States and worldwide. This presentation is a short summary of some wind lidar-related activities taking place in the country, and was presented by Andrew Clifton at the Task 32 meeting in December 2016 in his role as the U.S. Department of Energy-nominated country representative to the task.
Braun, Gerald W.; McCluer, H. K.
Geothermal energy is an indigenous environmentally benign heat source with the potential for 5000-10,000 GWe of power generation in the United States. Approximately 2535 MWe of installed capacity is currently operating in the U.S. with contracted power costs down to 4.6 cents/kWh. This paper summarizes: 1) types of geothermal resources; 2) power conversion systems used for geothermal power generation; 3) environmental aspects; 4) geothermal resource locations, potential, and current power plant development; 5) hurdles, bottlenecks, and risks of geothermal power production; 6) lessons learned; and 7) ongoing and future geothermal research programs.
Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid
family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication. DESIGN: Qualitative and quantitative...... and nonguided-family-centred-care-trained nurses. CONCLUSIONS: An adjusted framework for guided family-centred care implementation was successful in overcoming barriers and promoting facilitators. RELEVANCE TO CLINICAL PRACTICE: Insights gained from our pioneering work might help nurses in a similar context...
Manojlovich, Milisa; Saint, Sanjay; Forman, Jane; Fletcher, Carol E; Keith, Rosalind; Krein, Sarah
The purpose of this study, conducted in 3 intensive care units (ICUs) at 1 Department of Veterans Affairs Medical Center, was to develop tools and procedures to measure nurse/physician communication in future studies. We used mixed methods in a multistaged approach. Qualitative data came from 4 observations of patient care rounds and 8 interviews with nurses and physicians. Quantitative data came from anonymous surveys distributed to nurses in all 3 ICUs (n = 66). We administered the Safety Organizing Scale to measure nurses' self-reported behaviors that enable a safety culture. Analysis of variance was the main statistical test. Qualitative data were used to create an observation data collection tool and a working protocol, to measure nurse/physician communication in a future study. Analysis of variance revealed significant differences between the 3 units (f = 4.57, P = 0.02). There also were significant differences on 4 of 9 items of the Safety Organizing Scale. Using mixed methods, we gained multiple perspectives that helped us to clarify and validate the context and content of communication. Quantitative analysis showed significant differences between the 3 ICUs in nurses' perceptions of a safety culture. According to qualitative analyses, nurses from the unit which reported the weakest safety culture also were the least satisfied in their communication with physicians. Qualitative analyses corroborated quantitative findings and demonstrated the importance of contextual influences on nurse/physician communication. Through the tools and protocol we created, more realistic strategies to promote effective communication between nurses and physicians may be developed and tested in future studies.
Malouf-Todaro, Nabia; Barker, James; Jupiter, Daniel; Tipton, Phyllis Hart; Peace, Jane
Ventilator-associated pneumonia is a hospital-acquired infection that may develop in patients 48 hours after mechanical ventilation. The project goal was to determine whether a ventilator-associated pneumonia care bundle checklist embedded into an existing electronic health record would increase completeness of nursing documentation in an intensive care unit setting. With the embedded checklist, there were significant improvements in nursing documentation and a decreased incidence of ventilator-associated pneumonia.
Behavioral problems after a brain injury can be extremely challenging for those working with brain injured people. Nursing staff must be familiar with commonly used post brain injury medications and their effects, behavioral management plans, appropriate use of restrictive devices, and verbal or physical crisis intervention techniques when necessary. Rehabilitation nurses caring for brain injured patients on a locked neurobehavioral unit must maintain continual training and specific competence in this environment to ensure patient and staff safety.
Full Text Available Introduction: Stress is one of the main factors affecting one's efficiency as well as staff health and quality of nursing services. Neonatal intensive care units (NICUs can be stressful environments for nurses, infants and families as well. Since there is no evidence in this regard in Iran, the present study aimed to determine stress levels related to care delivering in NICU from the viewpoint of nurses in NICUs of East Azerbaijan Province, Iran during 2011.Methods: This was a descriptive study including a purposive sample of 110 nurses working in NICUs of hospitals in East Azerbaijan Province. The data collection tool was a self-report questionnaire. The validity and reliability of the questionnaire were assessed by content validity and Cronbach's alpha coefficient (α = 0.84.Results: According to factor analysis, the stressors included environmental and nurse and human factors. Stress sources in total and separately in each category were reported as moderate. The mean and 95% confidence interval of the factors in the categories were 2.75 (0.84; 2.59-2.91 and 3.21 (0.72; 3.07-3.35, respectively. Therefore, human factors caused significantly higher levels of stress compared to environmental factors (p < 0.05. Conclusion: Stressors involved in NICU nursing include environmental and human factors. Planning to remove or reduce their impact can improve the quality of nursing services in intensive care units and, thus, decrease the adverse effects of stress on workers.
Piedrafita-Susín, A B; Yoldi-Arzoz, E; Sánchez-Fernández, M; Zuazua-Ros, E; Vázquez-Calatayud, M
Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. Twenty seven articles for review were selected, most of them qualitative studies (n=16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units' nurses. This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Full Text Available Abstract Background The United Kingdom has recruited nurses from countries with a reported surplus in their nursing workforce, such as India and the Philippines. However, little is known about the decision to emigrate made by nurses from these countries. One theory suggests that individuals weigh the benefits and costs of migration: the push and pull factors. This paper challenges the restricted economic focus of this predominant theory and compares the diverse motivations of nurses from different countries as well as those of nurses with previous migratory experience and first-time migrants. Methods This research was undertaken in a National Health Service acute trust in London by means of a qualitative interpretative approach. Data were collected through face-to-face longitudinal and cross-sectional interviews with internationally recruited nurses from India (n = 6 and the Philippines (n = 15; and analysis of their narratives was used to generate data about their expectations and experiences. Data were analysed by means of a framework approach that allowed for intra-case and cross-case analysis. Results From an individual perspective, nurses in this study reported economic reasons as the main trigger for migration in the first instance. Yet this doesn't entirely explain the decision to move from previous migratory destinations (e.g. Saudi Arabia where economic needs are already fulfilled. In these cases migration is influenced by professional and social aspirations that highlight the influence of the cultural environment – specifically some religious and gender-related issues. Family support and support from migratory networks in the country of origin and destination were also important elements conducive to and supportive of migration. Nurses from India report coming to the United Kingdom to stay, while Filipina nurses come as temporary migrants sending remittances to support their families in the Philippines. Conclusion This study shows
Zoback, Mary Lou; Zoback, Mark
Inferring principal stress directions from geologic data, focal mechanisms, and in situ stress measurements, we have prepared a map of principal horizontal stress orientations for the conterminous United States. Stress provinces with linear dimensions which range between 100 and 2000 km were defined on the basis of the directions and relative magnitude of principal stresses. Within a given province, stress orientations appear quite uniform (usually within the estimated range of accuracy of the different methods used to determine stress). Available data on the transition in stress direction between the different stress provinces indicate that these transitions can be abrupt, occurring over characterized by high levels of seismicity and generally high heat flow, the stress pattern is complex, but numerous stress provinces can be well delineated. Despite relative tectonic quiescence in the eastern and central United States, a major variation in principal stress orientation is apparent between the Atlantic Coast and midcontinent areas. Most of the eastern United States is marked by predominantly compressional tectonism (combined thrust and strike slip faulting), whereas much of the region west of the southern Great Plains is characterized by predominantly extensional tectonism (combined normal and strike slip faulting). Deformation along the San Andreas fault and in parts of the Sierra Nevada is nearly pure strike slip. Exceptions to this general pattern include areas of compressional tectonics in the western United States (the Pacific Northwest, the Colorado Plateau interior, and the Big Bend segment of the San Andreas fault) and the normal growth faulting along the Gulf Coastal Plain. Sources of stress are constrained not only by the orientation and relative magnitude of the stresses within a given province but also by the manner of transition of the stress field from one province to another. Much of the modern pattern of stress in the western United States can be
Nicoletti, C. K.; Lopez-Morales, C. A.; Hoover, J. H.; Voigt, B. G.; Vorosmarty, C. J.; Mohammed, I. N.
There are an abundance of large-scale, coarse resolution global water scarcity studies, but the existing literature fails to address regional and state specific scarcity measures. Moreover, while environmental water requirements are an integral factor in the development and implementation of sustainable water management practices, only recently has this notion been introduced to water scarcity research. In this paper, we argue that developing a preliminary measure of water scarcity, at the regional and state levels, will allow for more informed policy development. The goal of this study is to generate a more comprehensive understanding of water scarcity in the Northeast, by gathering fine scale data, applying a consistent methodology to the calculation of a scarcity index, and analyzing the results to see relative trends in spatio-temporal water scarcity. Public supply, irrigation, rural, industrial and thermo-power withdrawals have been compiled from USGS state water use publications from 1950 to 1985. Using the WBMplus water model runoff data, state specific in-stream environmental water requirements were calculated using the accepted hydro-ecological methodology. Water scarcity was then calculated as a ratio of water withdrawals to total available water minus environmental flow requirements for the system. In so doing, this study generates a spatially explicit and temporally varying water scarcity indicator (WSI) for the Northeastern United States between 1950 and 2000 at the regional and state levels at a five-year time interval. Calculation of a spatial and temporal water scarcity indicator enabled us to identify regions and specific states that were: slightly exploited (WSI 1.0). The minimum environmental water requirements to maintain in-stream aquatic and riparian ecosystems for the Northeastern states ranged between 27.5 to 36.3 percent of the mean annual runoff within Vermont and Maryland, respectively. The regional WSI values ranged between 0.199 in 1950
Valls-Matarín, J; Salamero-Amorós, M; Roldán-Gil, C
To evaluate and assess the nursing workload (NW) scales by means of three scales and to determine the theoretical and real nurse/patient relationship in a polyvalent ICU. Cross-sectional descriptive study between July 2012 and June 2013 in patients over 18 years old, for which 3 nurses quantified, in randomized days, the NW by the Nursing Activities Score (NAS), Nine Equivalents Manpower Score (NEMS) and Valoración de Cargas de Trabajo y Tiempos de Enfermería (VACTE). Efficiency parameters of nursing resources were calculated: "work utilization ratio" (WUR), "level of care" operative (LOCop) and planned (LOCp). Data on demographics, length of stay and number of nurses were collected. 720 records were collected. The mean age was 64 (13.6) years. 73% were male and the median of length of stay was 3 (1-12) days. 60% were admitted for medical causes. The average total score was: NAS: 696.8 (111.6), NEMS: 311.8 (55.3) and VACTE: 4,978 (897.7). The required number of nurses according to NAS was 7 and 6,7 according to NEMS and VACTE. The actual average was 5.5. On all 3 scales the WUR was >1 and LOCop was 1.6 pacients/nurse. The LOCp was 2 patients/nurse. Assessing NW allows to know the reality of each unit. According to the scales and efficiency parameters of the nursing resources used, there is a shortage of nurses in relation to the work generated. NAS reflects more parameters of NW. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Le Blanc, Pascale M.; Schaufeli, Wilmar B.; Salanova, Marisa; Llorens, Susana; Nap, Raoul E.
P>Aim. This paper is a report of an investigation of whether intensive care nurses' efficacy beliefs predict future collaborative practice, and to test the potential mediating role of team commitment in this relationship. Background. Recent empirical studies in the field of work and organizational p
Swinny, Betsy; Brady, Melanie
The goal of providing a clinical rotation in a basic nursing program is to integrate skills and knowledge from the classroom setting into the clinical practice setting. In the intensive care unit (ICU), nursing students have the ability to learn about the complex health issues of critically ill patients, practice selected technical skills, and develop communication skills. There are both benefits and challenges to having nursing students in the intensive care setting. With preparation, the student is able to immerse in the ICU environment, acquire new knowledge and skills, and participate alongside the nurse caring for critically ill patients. The staff nurse must balance patient care with the added responsibilities of helping the student meet the clinical goals. It is optimal to have faculty that are also intensive care clinically competent and can facilitate the clinical experience. The school, the hospital, and the ICU need to collaborate to provide a positive clinical experience that is safe for the patient. In return, the hospital can recruit student nurses and clinical faculty. Planned with thought and intention, rotations in the ICU can be an ideal clinical setting for upper-level student nurses to learn the role of the registered nurse.
The breathtaking beauty of the western United States is apparent in this image from the Multi-angle Imaging SpectroRadiometer on NASA's Terra spacecraft. Data from 16 different swaths acquired between April 2000 and September 2001by MISR's vertical-viewing (nadir) camera were used to create this cloud-free natural-color image mosaic. The image is draped over a 100-meter (328-foot)shaded relief Digital Terrain Elevation Model from the United States Geological Survey.Among the prominent features are the snow-capped Rocky Mountains traversing Montana, Wyoming, Colorado and New Mexico. In the northern portion of the image, the Columbia Plateau stretches across Washington, Oregon and Idaho. Many major rivers originate in this region, including the Missouri to the east of the Continental Divide, the Snake to the west, and the Colorado which wends across Utah and Arizona. The Colorado Plateau and vibrant red-colored rocks of the Painted Desert extend south from Utah into Arizona. In the southwestern portion of the image, California's San Joaquin Valley and the Mojave Desert of California and Nevada give way to the Los Angeles basin and the Pacific Ocean.The Terra spacecraft is part of NASA's Earth Science Enterprise, a long-term research and technology program designed to examine Earth's land, oceans, atmosphere, ice and life as a total integrated system.
Kuiper, J.A.; Hlava, K.Greenwood, H.; Carr, A. (Environmental Science Division)
The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. It is designed for the U.S. Department of Agriculture Forest Service (USFS) and other federal land management agencies to evaluate existing and proposed renewable energy projects. Much of the content of the Atlas was compiled at Argonne National Laboratory (Argonne) to support recent and current energy-related Environmental Impact Statements and studies, including the following projects: (1) West-wide Energy Corridor Programmatic Environmental Impact Statement (PEIS) (BLM 2008); (2) Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2010); (3) Supplement to the Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2011); (4) Upper Great Plains Wind Energy PEIS (WAPA/USFWS 2012, in progress); and (5) Energy Transport Corridors: The Potential Role of Federal Lands in States Identified by the Energy Policy Act of 2005, Section 368(b) (in progress). This report explains how to add the Atlas to your computer and install the associated software; describes each of the components of the Atlas; lists the Geographic Information System (GIS) database content and sources; and provides a brief introduction to the major renewable energy technologies.
On September 16, 2015, the United States Department of Agriculture (USDA) and the United States Environmental Protection Agency (EPA) announced the first ever domestic goal to reduce food loss and waste by half by the year 2030.
U.S. Geological Survey, Department of the Interior — This is a line coverage of average annual runoff in the conterminous United States, 1951-1980. Surface runoff Average runoff Surface waters United States
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Schedule of Charges Outside the United States AGENCY: Federal Aviation... for services of FAA Flight Standards Aviation Safety Inspectors outside the United States....
U.S. Geological Survey, Department of the Interior — This map layer shows the coal fields of Alaska and the conterminous United States. Most of the material for the conterminous United States was collected from James...
Compares the number of legal abortions performed in the United States and Britain. Reveals that the rate of abortion in the United States is more than twice that of Britain. Analyzes the reasons for the different rates. (Author)
U.S. Geological Survey, Department of the Interior — The Satellite View of the Conterminous United States map layer is a 200- meter-resolution simulated-natural-color image of the United States. Vegetation is generally...
This paper compares the differences in constitutional spirit between United States and China, and then brings out the influence of the constitutional spirit in United States to the constitutional spirit in China.
Barchet, W.R.; Davis, W.E.
In this study the geographic domain covered the 48 conterminous states of the United States. The daily synoptic weather pattern was classified into nine types for the 10-year period January 1, 1969 to December 31, 1978. Weather pattern types were defined relative to the classical polar front model of a mid-latitude cyclonic storm system and its associated air masses. Guidelines for classifying weather patterns on an operational basis were developed. These were applied to 3652 daily surface weather maps to produce a time series of weather pattern type at 120 grid points of a 160 point, 3/sup 0/ latitude by 4/sup 0/ longitude array over the United States. Statistics on the frequency of occurrence, persistence and alternation of weather patterns were calculated for each grid point. Summary statistics for the entire grid and for six regions were also presented. Frequency of occurrence and persistence were found to depend on the size and speed of movement of the weather pattern. Large, slow moving air masses had higher frequency of occurrence and longer persistence than small (fronts) or rapidly moving (or changing) features (fronts, storm centers). Some types showed distinct regional preferences. The subtropical maritime high occurred mainly in the south central and southeast. An indeterminate weather pattern type accounted for those weather patterns that did not fit the polar front model or were too disorganized to be classified. The intermountain thermal low of the desert southwest was one such feature that dominated both frequency of occurrence and persistence in this region. Alternation from one weather pattern to another followed the polar front model of a moving cyclonic storm. The tendency for anticyclonic weather patterns to become disorganized as they weakened was seen in the high percentage of these patterns that changed to an indeterminate pattern as they aged.
Rosana Alameda Varela
Full Text Available Nosocomial infection is one of the most common causes of adverse events and complications related to health care. Development of nosocomial infection is associated with an increase in hospital stay and mortality and an overall increase in health care costs. Knowing the incidence of nosocomial infection is an effective way of controlling and preventing it. Identifying the relationship between nursing workload and nosocomial infections in critical care may be helpful to adjust the staff to the real requirements of the intensive care unit and may help reducing costs. The aim of the present study is to analyze the influence of nursing workload in the development of nosocomial infections in patients admitted to an intensive care unit. A longitudinal correlational research will be performed. The sample will be comprised of the patients admitted in the intensive care unit of the Hospital Universitario Fundación Alcorcón.Data regarding sociodemographical variables, ventilador-associated pneumonia, intravascular catheter location and duration, urinary catheter type and duration, and all pertinent cultures will be obtained from the medical records. Nursing Activities Score scale will be used to assess daily nursing workload in the unit. The number of patients admitted daily, as well as the number of nursing professionals working in each shift will also be taken into account.
Thompson, C; McCaughan, D; Cullum, N; Sheldon, T A; Mulhall, A; Thompson, D R
The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals. Three perspectives on accessibility were identified: (a) the humanist--in which human sources of information were the most accessible; (b) local information for local needs--in which locally produced resources were seen as the most accessible and (c) moving towards technology--in which information technology begins to be seen as accessible. Nurses' experience in a clinical specialty is positively associated with a perception that human sources such as clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely to perceive local guidelines, protocols and on-line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text-based resources available to nurses on the wards had any explicit research base. These, and the remainder were out of date (mean age of textbooks 11 years), and authorship hard to ascertain. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles could act as 'conduits' through which research-based messages for practice, and information
Parmer, John; Allen, Leeanna; Walton, Wanda
: Nurses play a critical role in the diagnosis and treatment of tuberculosis and in the prevention of tuberculosis transmission through infection control practices. To eliminate tuberculosis in the United States, however, an expanded approach to testing and treating people with latent tuberculosis infection must be implemented. Recently, the U.S. Preventive Services Task Force (USPSTF) issued a new recommendation statement on latent tuberculosis infection testing that expands nurses' opportunities to identify at-risk populations for tuberculosis prevention. In combination with newer testing methodologies and shorter treatment regimens, implementation of the USPSTF recommendation has the potential to remove previously existing barriers to screening and treatment of both patients and health care providers. This article provides a general overview of tuberculosis transmission, pathogenesis, and epidemiology; presents preventive care recommendations for targeted testing among high-risk groups; and discusses the USPSTF recommendation's applicability to public health and primary care practice in the United States.
... Tool for State Nursing Homes Receiving Per Diem Payments From VA AGENCY: Department of Veterans Affairs... diem from VA for providing nursing home care to veterans. The proposed rule would require State nursing... Required Assessment Tool for State Nursing Homes Receiving Per Diem Payments From VA.'' Copies of...
Full Text Available This paper describes and explores the clinical learning needs and expectations of student nurses. An exploratory, descriptive and qualitative design, which is contextual in nature, was used where a focus group interview was conducted with the final year basic students undergoing a four year comprehensive diploma course leading to registration as a professional nurse. Tecsh’s (in Cresswell, 1994:155 method of data analysis was employed. Eight categories were identified as follows: communication; role modelling; up-to-date knowledge and experience; continuous supervision; assessment and evaluation; scientific process; management; professional practice and student status. A recommendation deduced from the conclusions made on the identified clinical learning needs and expectations of the students should enable teachers to address the long standing problem of how students should learn.
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the Vietnam-United States relationship has taken giant steps forward in virtually every aspect, especially solidified by a Comprehensive Partnership... platform for future relationship between Vietnam and the United States. Finally, this research suggests a framework for naval cooperation between Vietnam...United States relationship has taken giant steps forward in virtually every aspect, especially solidified by a Comprehensive Partnership Agreement signed
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... to trade in textile and apparel goods between Peru and the United States. The provisions within...] RIN 1515-AD79 United States-Peru Trade Promotion Agreement AGENCIES: U.S. Customs and Border... of the United States- Peru Trade Promotion Agreement. DATES: Interim rule effective November 3, 2011...
... Internal Revenue Service 26 CFR Part 1 RIN 1545-BK10 Modifications to Definition of United States Property... clearing agency do not constitute United States property. The text of the temporary regulations also serves... Federal Register establish an exception to the definition of United States property (within the meaning...
Freeman, Samantha; Hallett, Christine; McHugh, Gretl
Patients within the adult intensive care unit have the potential to develop delirium and agitation. This can result in the patient displaying unwanted behaviours such as attempting to remove the medical devices to which they are attached. Some adult intensive care units within the UK are starting to adopt physical restraint as a method of managing unwanted behaviours. To determine the experiences, attitudes and opinions of adult intensive care nurses in relation to the application of physical restraint. Questionnaire survey. A postal questionnaire was distributed to all nurses (n = 192) within two purposefully selected large adult intensive care units in the UK. Data were collected between November 2012 and February 2013. The questionnaire was completed by 38·9% (n = 75) of the nurses contacted. All believed that physical restraint had a place, with the majority of the view that the reason for its application was to maintain patient safety. Some expressed discomfort about the use of physical restraint. Nurses were happy to discuss the use of restraint with families. There was a perceived need for training and support for nursing staff as well as the need for medical staff to support the decision-making process. Nurses require more support and evidence to base their decision-making upon. They require guidance from professional bodies as well as support from medical colleagues. The findings have limited generalizability as they can only be applied to the units accessed and the response rate was poor. Alternative approaches such as pain management, sleep promotion and the involvement of relatives need to be explored before physical restraint policy can be written. Further research is required into the safety of physical restraint, alternative methods of managing the risk of agitation and identifying predisposing factors to accidental device removal. © 2015 British Association of Critical Care Nurses.
Full Text Available Southeast Asia has historically been a meeting point between East Asia and South Asia before Western colonialism opened the region to the West and to the winds of global modernization. Since Japan’s coercive decolonization during the Second World War, the dominant outside influences have come from the United States and from the People’s Republic of China. The post-Cold War era began with a withdrawal of both China’s and US power projection from Southeast Asia, facilitating the configuration of a triangular ménage à trios, with ASEAN expanding to include all of Southeast Asia and introducing a number of extended forums intended to socialize the rest of East Asia into the ASEAN way. The “rise of China” occurred within this friendly context, though beginning around 2010 its strategic implications began to appear more problematic with the mounting dispute over the issue of the South China Sea.
C. Kenneth Tanner
Full Text Available School reform issues addressing inclusive education were investigated in this nationwide (United States study. A total of 714 randomly selected middle school principals and teachers responded to concerns about inclusion, "degree of change needed in" and "importance of" collaborative strategies of teaching, perceived barriers to inclusion, and supportive activities and concepts for inclusive education. There was disagreement among teachers and principals regarding some aspects of inclusive education and collaborative strategies. For example, principals and special education teachers were more positive about inclusive education than regular education teachers. Collaboration as an instructional strategy for "included" students was viewed as a high priority item. Responders who had taken two or more courses in school law rated the identified barriers to inclusive education higher than those with less formal training in the subject.
Strange, W. E.; Vincent, S. F.; Berry, R. H.; Marsh, J. G.
A detailed gravimetric geoid was computed for the United States using a combination of satellite-derived spherical harmonic coefficients and 1 by 1 deg mean gravity values from surface gravimetry. Comparisons of this geoid with astrogeodetic geoid data indicate that a precision of plus or minus 2 meters has been obtained. Translations only were used to convert the NAD astrogeodetic geoid heights to geocentric astrogeodetic heights. On the basis of the agreement between the geocentric astrogeodetic geoid heights and the gravimetric geoid heights, no evidence is found for rotation in the North American datum. The value of the zero-order undulation can vary by 10 to 20 meters, depending on which investigator's station positions are used to establish it.
Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1994, the wholesale trade market totaled 1.9 trillion kilowatthours, about 66% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1994 (ELECTRA), is the fifth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1994.
Kuiper, J. [Environmental Science Division; Hlava, K. [Environmental Science Division; Greenwood, H. [Environmentall Science Division; Carr, A. [Environmental Science Division
The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. This report explains how to add the Atlas to your computer and install the associated software. The report also includes: A description of each of the components of the Atlas; Lists of the Geographic Information System (GIS) database content and sources; and A brief introduction to the major renewable energy technologies. The Atlas includes the following: A GIS database organized as a set of Environmental Systems Research Institute (ESRI) ArcGIS Personal GeoDatabases, and ESRI ArcReader and ArcGIS project files providing an interactive map visualization and analysis interface.
Demand for medical equipment in the United States (US) is projected to grow by 8% between 2001 and 2006, to reach 105 billion dollars. In 2001,the market was valued at 71.4 billion dollars, based on an annual growth of 7.5% between 1996 and 2001, according to The Freedonia Group. Product innovation and the growing ageing population is driving the industry, despite health-care cost containment measures. Medical and surgical instruments continue to be the largest sector, which is expected to grow to 30.5 billion dollars in 2006. However, electromedical/electrotherapeutic apparatus will remain the fastest growing sector, with annual gains of 10.8% predicted for this period.
Sanchez, Guillermo V.; Roberts, Rebecca M.; Albert, Alison P.; Darcia D. Johnson; Hicks, Lauri A.
Appropriate selection of antibiotic drugs is critical to optimize treatment of infections and limit the spread of antibiotic resistance. To better inform public health efforts to improve prescribing of antibiotic drugs, we conducted in-depth interviews with 36 primary care providers in the United States (physicians, nurse practitioners, and physician assistants) to explore knowledge, attitudes, and self-reported practices regarding antibiotic drug resistance and antibiotic drug selection for ...
Full Text Available United States strives to force the Chinese into agreement of increasing the value of their exchange rate to help the USA avoid inflation As China did not come into an agreement with the USA, Tariffs are being put on Chinese products entering USA. However China as began to add tariff on poultry received from the US as well. China was previously not named in the legislation permitting US to add tariff on their goods. But recently a bill was passed giving the commerce department the ability to place important tariffs on all countries to undervalue their currency. The bill passed in legislation had the support of 99 republicans. China has been managing their currency in a manner that makes their goods cheaper to sell and American goods more expensive. The Chinese manipulation of their currency has been quite expensive for the USA, as it has cost them $1.5 billion jobs increasing the percentage of unemployment greatly and significantly. This imposition of tariffs on Chinese goods could result in effecting $300 billion dollars worth of their products. It is obvious that the Americans are attempting to improve and acknowledge their growth and power. As predictions have developed over this conflict, arguing the fact that China will not negotiate with the USA at this point rather fight back and also approach in adding tariffs on USimports. However, this reaction by the Chinese will only worsen the scenario and result in the possible inflation of the US economy or worldwide trade war. This is a very sensitive time for the United States as their biggest hopes are dependent on the Chinese. But it doesn’t look like they will be too satisfied with the outcome.
Wilson, J; Mohnen, V; Kadlecek, J
Attempts are made to examine concentration and wet deposition of pollutant material at selected stations within the northeastern United States and to characterize as many events as possible with respect to air mass origin. Further attempts are made to develop a regional pattern for the deposition of dominant ion species. MAP3S (US Multistate Atmospheric Power Production Pollution Study) data for 1977 to 1979 are used to determine concentration and deposition on an event basis from which monthly, seasonal, annual, and cumulative averages are developed. The ARL-ATAD trajectory model is used to characterize individual events as to air mass origin. Case studies are examined to illustrate variability in the chemical composition of precipitation originating from distinctly different air mass trajectories. A difference in concentration of pollution-related ions in precipitation is noted between Midwest/Ohio Valley and Great Lakes/Canadian air mass origins for carefully selected cases. Total deposition of the major ions is examined in an effort to develop a regional pattern for deposition over a period of at least one year. For that purpose, total deposition is normalized to remove the variability in precipitation amounts for inter-station comparison. No marked gradient is noted in the normalized deposition totals within the northeast of the United States. The Adirondack region exhibited the lowest normalized ion deposition value, while the Illinois station showed the highest of the MAP3S network. The data analysis suggest that the acid rain phenomena covers the entire northeast. The concept of large scale mixing emerges to account for the lack of a significant gradient in the normalized deposition.
Full Text Available United States strives to force the Chinese into agreement of increasing the value of their exchange rate to help the USA avoid inflation As China did not come into an agreement with the USA, Tariffs are being put on Chinese products entering USA. However China as began to add tariff on poultry received from the US as well. China was previously not named in the legislation permitting US to add tariff on their goods. But recently a bill was passed giving the commerce department the ability to place important tariffs on all countries to undervalue their currency. The bill passed in legislation had the support of 99 republicans. China has been managing their currency in a manner that makes their goods cheaper to sell and American goods more expensive. The Chinese manipulation of their currency has been quite expensive for the USA, as it has cost them $1.5 billion jobs increasing the percentage of unemployment greatly and significantly. This imposition of tariffs on Chinese goods could result in effecting $300 billion dollars worth of their products. It is obvious that the Americans are attempting to improve and acknowledge their growth and power. As predictions have developed over this conflict, arguing the fact that China will not negotiate with the USA at this point rather fight back and also approach in adding tariffs on US
imports. However, this reaction by the Chinese will only worsen the scenario and result in the possible inflation of the US economy or worldwide trade war. This is a very sensitive time for the United States as their biggest hopes are dependent on the Chinese. But it doesn’t look like they will be too satisfied with the outcome.
Wilson, J; Mohnen, V; Kadlecek, J
Mª Cristina Pascual Fernández
Full Text Available When the patients are in the end-of-life, the cares would focus to favor a good death, for that reason the nursing staff must know how to integrate the death like a part of the life, being avoided that produces anxiety to them before the possibility of taking part its own fears to the death. The core of nursing staff in intensive care units is to maintain life of their patients, reason why the end-of life in them is not easy or natural.Objective: Evaluate the death anxiety levels in intensive care nursing staff.Material and method: An observational study was conducted descriptive cross hospital adult and Paediatric ICU General University Gregorio Marañón Hospital, through survey to nurses and auxiliary nurses of those units.The anxiety inventory was used to Death (Death Anxiety Inventory [DAI] for the assessment of anxiety before death. Outcomes: Paediatric ICU nurses have higher levels of anxiety that the adult ICU as well as the less experienced professionals and those declared not feel trained in the subject.Conclusions: Experience and the training are key elements that help professionals face to death, from management we must ensure that patients in stage terminal are served by professionals with this profile.
Malliarou, Maria; Gerogianni, Georgia; Babatsikou, Fotoula; Kotrotsiou, Evaggelia; Zyga, Sofia
This study was done in order to examine the role of the nurse in families with critically ill patients as perceived by family members. A descriptive design was conducted with 93 family members aged 18-53 years from a 6-bed intensive care unit in a Greek Hospital. An anonymous self-completed questionnaire recording demographic data and the questionnaire Family members perception of nurses behavioral role expectation/enactment scale of Hickey and Lewandowski was used. Parametric statistic tests were used to examine the research questions. Intensive care unit (ICU) patients' family members expect nurses to make them feel they can ask whatever they want whenever they want, placing great emphasis on communicating with one another and on participating in decision making to the progress of patient care. The age seems to correlate with the expectation from nurse to meet the role of training on how to handle the patient. Nurses did well with regard to meeting family members' expectations. Most family members assessed positively the role of ICU nurse confirming the need for communication, and clear support of families.
Oxenbøll-Collet, Marie; Egerod, Ingrid; Christensen, Vibeke;
of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. METHODS: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide. Five focus groups with nurses (n = 20) and four...... with physicians (n = 14) were conducted. Strategic sampling was used to include participants with varying CAM-ICU experience at units, with variable implementation of the tool. RESULTS: Using a hermeneutical approach, three main themes and nine sub-themes emerged. The main themes were (1) Professional role issues......: CAM-ICU screening affected nursing care, clinical judgment and professional integrity; (2) Instrument reliability: nurses and physicians expressed concerns about CAM-ICU assessment in non-sedated patients, patients with multi-organ failure or patients influenced by residual sedatives/opioids; and (3...
Pölkki, Tarja; Korhonen, Anne; Laukkala, Helena
This study aimed to describe nurses' expectations of using music for premature infants in the neonatal intensive care unit (NICU) and to find out about the related background factors. The subjects consisted of 210 Finnish nurses who were recruited from the country's five university hospitals providing premature infant care in NICU. The data were collected by validated questionnaire, and the response rate was 82%. Most nurses preferred recorded music to live music in the NICU. They expected that music would have positive effects on premature infants, parents, and staff. Few demographic and many background factors of the respondents' music-related experiences correlated significantly with the expectations concerning their preference. In conclusion, the nurses' expectations were positive regarding the use of music in the NICU, which supports evidence regarding the efficacy of music therapy for premature infants.
Cho, Ok Min; Kim, Hwasoon; Lee, Young Whee; Cho, Insook
The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. One bed out of 56 ICU beds was randomly assigned to each observation time unit. Overall 2,184 clinical alarms were counted for 48 hours of observation, and 45.5 clinical alarms occurred per hour per subject. Of these, 1,394 alarms (63.8%) were categorized as false alarms. The alarm fatigue score was 24.3 ± 4.0 out of 35. The highest scoring item was "always get bothered due to clinical alarms". The highest scoring item in obstacles was "frequent false alarms, which lead to reduced attention or response to alarms". Nurses reported that they felt some fatigue due to clinical alarms, and false alarms were also obstacles to proper management. An appropriate hospital policy should be developed to reduce false alarms and nurses' alarm fatigue.
Clairton Marcos Citolino Filho
Full Text Available Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%, the lack of harmony (77.6% or stress of any member of staff (67.3%, lack of material and/or equipment failure (57.1%, lack of familiarity with the emergency trolleys (98.0% and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1% are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.
... International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade Administration, U.S. Department of Commerce... meeting of the United States Travel and Tourism Advisory Board (Board). The Board will meet to present...
... International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade Administration, U.S. Department of Commerce... meeting of the United States Travel and Tourism Advisory Board (Board). This will be the last meeting of...
Specht, Jennifer A.
After an examination of the current issues related to the shortages of nurses and nursing faculty in the United States, the importance of facilitating the transition of interested nurse clinicians into their roles as nurse educators in order to address the decreased number of nurses and nursing faculty became apparent. Mentoring in nursing…
... AFFAIRS Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring and Retaining Nurses at State Homes) Activity: Comment Request AGENCY... information needed to determine State Veterans' Homes eligibility for funding for programs to recruit and...
... AFFAIRS Proposed Information Collection (Regulation on Reduction of Nursing Shortages in State Homes; Application for Assistance for Hiring and Retaining Nurses at State Homes) Activity: Comment Request AGENCY... information needed to determine State Veterans' Homes eligibility for funding for programs to recruit and...
Trzpuc, Stefnee J; Martin, Caren S
Additional research is needed to explore how the design of urban, medical-surgical nursing units influences communication patterns, perceptions of social support, and overall job satisfaction for nurses. Space syntax theory has typically been used to study communication in office environments; more recently, it has been applied to the study of healthcare environments. The purpose of this study was to explore the applicability of space syntax theory as a theoretical framework for studying nurses' communication in medical-surgical nursing units in urban hospitals. The nursing profession is rapidly changing, and nurses' work is psychologically and physically intense. At the same time, nurses are responsible for patient safety, optimal care delivery, and patient outcomes (Bureau of Labor Statistics, 2009; Clarke, 2007; Clarke & Donaldson, 2008; Institute of Medicine, 2000; Institute of Medicine, 2004). Nurses are central to the delivery of care and act as a conduit for communication among members of the patient care team. Some of the design characteristics that create a more appealing environment for patients, such as views of nature and single-patient rooms, may not be fully understood as they relate to nurses' tasks and responsibilities, and they could be detrimental to nursing communication. This study analyzed three medical-surgical nursing unit floor plans using two constructs of space syntax theory, and it verified analysis through three semi-structured interviews with end users. The use of space syntax theory for analyzing medical-surgical nursing unit floor plans is complex. Findings indicated that nurses' perceptions of two constructs of space syntax theory, visibility and accessibility, did not consistently match the anticipated benefits of the floor plan designs. Understanding how and when nurses communicate with each other could help designers of healthcare spaces create more effective environments that support nurses' work and personal health and welfare
Kiekkas, Panagiotis; Karga, Maria; Poulopoulou, Maria; Karpouhtsi, Irini; Papadoulas, Vasileios; Koutsojannis, Constantinos
The aim of this study was to determine the perceptions of nurses who work in critical care units about positive and negative effects related to the use of technological equipment and identify relationships between these perceptions and demographic characteristics of participants. Previous researchers have investigated the perceptions of nursing personnel about the effects of technology on clinical practice. However, most of them focus on specific negative effects. Positive and negative effects have never been studied as a whole. Critical care nurses were surveyed to elicit their perceptions regarding the use of technological equipment. The instrument comprised a 14-item questionnaire and a series of demographic characteristics. A five-point Likert scale was used for each of these 14 questions. The questionnaire was administered to 122 nurses working at the four critical care units of a major academic hospital in Patras, Greece, from 1/10/2003 to 31/12/2003. The completion of the questionnaires was achieved by means of a personal interview. A total of 118 questionnaires were completed. The majority of nurses recognized the positive effects of equipment regarding patient care and clinical practice. At the same time, they agreed that use of equipment possibly leads to increased risk due to human errors or mechanical faults, increased stress and restricted autonomy of nursing personnel. The use of machines does not add to nursing prestige and this may be related to decreased autonomy. Human errors, mechanical faults and increased stress do not seem to come as a result of time constriction but rather of inadequate education. Undergraduate and continuing education should respond efficiently to the needs of contemporary critical care. Recognition of positive and negative effects of machines through the investigation of perceptions of nurses is the first step before looking for ways of maximizing advantages and facing disadvantages of equipment use.
Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis
To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.
Stanton, Jennifer S.; Anning, David W.; Brown, Craig J.; Moore, Richard B.; McGuire, Virginia L.; Qi, Sharon L.; Harris, Alta C.; Dennehy, Kevin F.; McMahon, Peter B.; Degnan, James R.; Böhlke, John Karl
For some parts of the Nation, large-scale development of groundwater has caused decreases in the amount of groundwater that is present in aquifer storage and that discharges to surface-water bodies. Water supply in some areas, particularly in arid and semiarid regions, is not adequate to meet demand, and severe drought is affecting large parts of the United States. Future water demand is projected to heighten the current stress on groundwater resources. This combination of factors has led to concerns about the availability of freshwater to meet domestic, agricultural, industrial, mining, and environmental needs. To ensure the water security of the Nation, currently  untapped water sources may need to be developed.Brackish groundwater is an unconventional water source that may offer a partial solution to current and future water demands. In support of the national census of water resources, the U.S. Geological Survey completed the national brackish groundwater assessment to better understand the occurrence and characteristics of brackish groundwater in the United States as a potential water resource. Analyses completed as part of this assessment relied on previously collected data from multiple sources; no new data were collected. Compiled data included readily available information about groundwater chemistry, horizontal and vertical extents and hydrogeologic characteristics of principal aquifers (regionally extensive aquifers or aquifer systems that have the potential to be used as a source of potable water), and groundwater use. Although these data were obtained from a wide variety of sources, the compiled data are biased toward shallow and fresh groundwater resources; data representing groundwater that is at great depths and is saline were not as readily available.One of the most important contributions of this assessment is the creation of a database containing chemical characteristics and aquifer information for the known areas with brackish groundwater
Joyce, Beverley; Wallbridge, Hal
1. Suicide of a psychiatric inpatient can have significant, although diverse, effects on the emotions and behavior of both individual nurses and team functioning. 2. The majority of participants in this study felt there was a need for formal debriefing or counseling for themselves and their colleagues after a critical incident, although there was less consensus about the timing and structure of such an intervention. 3. This research highlights the need for advanced training of critical incident stress management team members and for flexibility in the application of critical incident stress management techniques.
Paunova, Minna; Li-Ying, Jason
Team cohesion is a critical factor in the provision of high-quality care, yet its antecedents remain understudied, particularly in the context of some healthcare professional groups where structural and individual constraints coexist, and demand for high quality performance is prevailing....... In this study, we focus on the nursing group in intensive care units (ICU). Not researched, yet important for employee attitudes towards their workplaces and workgroups, is the interface between the characteristics of individual care providers and those of the teams and organizations in which they are employed...... their teams as cohesive. A multi-source and multi-level study of approximately 140 nurses employed in 20 ICUs across Denmark demonstrates the critical role of self-concept in easing and enhancing the constraints workplaces impose on team cohesion. Furthermore, the study confirms the positive relationship...
Emee Vida Estacio
Full Text Available In this article, we explore the experiences of racial microaggression among migrant nurses in the United Kingdom. Eleven migrant nurses kept a reflective diary for 6 weeks to record and reflect on their experiences of living and working in the United Kingdom. The diary entries were then thematically analyzed. The results suggest that migrant nurses experienced racial microaggression from patients and colleagues through racial preferences and bullying. Institutional racism also hindered their opportunities for further training and promotion. As a result, some experienced feelings of anger, frustration, and even paranoia. Despite the negative consequences of racial microaggression on their emotional well-being, incidents were downplayed as trivial because of their vague and subtle nature. To encourage better multicultural interactions in the workplace, supportive organizational infrastructures need to be in place to enhance diversity awareness and to improve mechanisms for reporting and dealing with cases of racial microaggression.
Emee Vida Estacio
Full Text Available In this article, we explore the experiences of racial microaggression among migrant nurses in the United Kingdom. Eleven migrant nurses kept a reflective diary for 6 weeks to record and reflect on their experiences of living and working in the United Kingdom. The diary entries were then thematically analyzed. The results suggest that migrant nurses experienced racial microaggression from patients and colleagues through racial preferences and bullying. Institutional racism also hindered their opportunities for further training and promotion. As a result, some experienced feelings of anger, frustration, and even paranoia. Despite the negative consequences of racial microaggression on their emotional well-being, incidents were downplayed as trivial because of their vague and subtle nature. To encourage better multicultural interactions in the workplace, supportive organizational infrastructures need to be in place to enhance diversity awareness and to improve mechanisms for reporting and dealing with cases of racial microaggression.
Saharia, Manabendra; Kirstetter, Pierre-Emmanuel; Vergara, Humberto; Gourley, Jonathan J.; Hong, Yang
Floods have gained increasing global significance in the recent past due to their devastating nature and potential for causing significant economic and human losses. Until now, flood characterization studies in the United States have been limited due to the lack of a comprehensive database matching flood characteristics such as peak discharges and flood duration with geospatial and geomorphologic information. The availability of a representative and long archive of flooding events spanning 78 years over a variety of hydroclimatic regions results in a spatially and temporally comprehensive flood characterization over the continental U.S. This study, for the first time, employs a large-event database that is based on actual National Weather Service (NWS) definitions of floods instead of the frequently-adopted case study or frequentist approach, allowing us to base our findings on real definitions of floods. It examines flooding characteristics to identify how space and time scales of floods vary with climatic regimes and geomorphology. Flood events were characterized by linking flood response variables in gauged basins to spatially distributed variables describing climatology, geomorphology, and topography. The primary findings of this study are that the magnitude of flooding is highest is regions such as West Coast and southeastern U.S. which experience the most extraordinary precipitation. The seasonality of flooding varies greatly from maxima during the cool season on the West Coast, warm season in the desert Southwest, and early spring in the Southeast. The fastest responding events tend to be in steep basins of the arid Southwest caused by intense monsoon thunderstorms and steep terrain. The envelope curves of unit peak discharge are consistent with those reported for Europe and worldwide. But significant seasonal variability was observed in floods of the U.S. compared to Europe that is attributed to the diversity of causative rainfall ranging from synoptic
Navabi, Nasrin; Ghaffari, Fatemeh; Shamsalinia, Abbas; Faghani, Safieh
Introduction The need for valid, reliable, and objective tools has always been emphasized in studies related to the clinical assessment of nursing students. The aims of this study were to develop and assess the validity and reliability of the tools used to evaluate the clinical pharmacology unit. Methods This study was a methodological one, conducted in 2016. An item pool was developed based on the literature review and personal interviews with faculty members. The tool’s validity was determined through assessment of face validity, content validity, and construct validity, using exploratory factor analysis on the data provided by 264 second- and third-semester nursing students of the Islamic Azad University of Babol University of Medical Sciences. Reliability was determined through internal and external consistency, using a Cronbach’s coefficient of the correlation between classes. Results Based on the exploratory factor analysis, all items with a special value of >1 were grouped into six factors: 1) professional behavior; 2) effective communication; 3) recognition of medical terminology; 4) nursing actions before administering medicine; 5) nursing actions while administering medicine; and 6) nursing actions after administering medicine. These factors explained 77% of the total variance of the concept of assessment of the clinical pharmacology unit. In this study, reliability was demonstrated by a Cronbach’s alpha coefficient of 0.96; the correlation coefficient between floors for the total tool was 0.91, ranging from 0.64 to 0.89 in its dimensions. Conclusion The evaluation tool of the clinical pharmacology unit has an acceptable construct validity and satisfactory reliability and validity. Therefore, it can be used to evaluate the clinical pharmacology unit in the nursing education system in Iran. PMID:28008285
Kern County Superintendent of Schools, Bakersfield, CA.
This teaching unit, Nursing, is one in a series of career guides developed by Project CHOICE (Children Have Options in Career Education) to provide the classroom teacher with a source of career-related activities linking third and fourth grade elementary classroom experiences with the world of work. Part of the Health Occupations Career Cluster,…
Pallaro, Audrey; Polzin, Karine
Collaborative work forms part of the well-treatment and improvement of quality of care approach. It is also of benefit to the medical and paramedical teams. Within the parent-child unit of Libourne hospital, the midwife and child health nurse collaborate throughout the pregnancy, and especially during the post-partum period. The teams work together notably around the care of "high-risk" births and in particular when the newborn is hospitalised in a kangaroo care unit.
Hossein Dargahi; Golsa Shaham
Healthcare workers suffer from work-related or occupational stress. This can lead to severe distress, burnout or physical illness, and finally to decrease quality of work life and services provision. Nurses must be aware of retential stressors, because they add to the cumulative effect of other stressful events. Holmes and Rahe both found a relationship between life change unit as stressors and health changes. This research reported here aims to measure the life change units as stressors amon...
Rushton, Cynda Hylton; Schoonover-Shoffner, Kathy; Kennedy, Maureen Shawn
: To examine practices for addressing moral distress, a collaborative project was developed by the Johns Hopkins Berman Institute of Bioethics, the Johns Hopkins School of Nursing, the American Journal of Nursing, and the Journal of Christian Nursing, along with the American Association of Critical-Care Nurses and the American Nurses Association. Its purpose was to identify strategies that individuals and systems can use to mitigate the detrimental effects of moral distress and foster moral resilience. On August 11 and 12, 2016, an invitational symposium, State of the Science: Transforming Moral Distress into Moral Resilience in Nursing, was held at the Johns Hopkins School of Nursing in Baltimore, Maryland. Forty-five nurse clinicians, researchers, ethicists, organization representatives, and other stakeholders took part. The result of the symposium was group consensus on recommendations for addressing moral distress and building moral resilience in four areas: practice, education, research, and policy. Participants and the organizations represented were energized and committed to moving this agenda forward.
Henley, S Jane; Singh, Simple; King, Jessica; Wilson, Reda; Ryerson, Blythe
Cancer has many causes, some of which can, at least in part, be avoided through interventions known to reduce cancer risk. Healthy People 2020 objectives call for reducing colorectal cancer incidence to 38.6 per 100,000 persons, reducing late-stage breast cancer incidence to 41.0 per 100,000 women, and reducing cervical cancer incidence to 7.1 per 100,000 women. To assess progress toward reaching these Healthy People 2020 targets, CDC analyzed data from U.S. Cancer Statistics (USCS) for 2010. USCS includes incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System. In 2010, a total of 1,456,496 invasive cancers were reported to cancer registries in the United States (excluding Arkansas and Minnesota), an annual incidence rate of 446 cases per 100,000 persons, compared with 459 in 2009. Cancer incidence rates were higher among men (503) than women (405), highest among blacks (455), and ranged by state from 380 to 511 per 100,000 persons. Many factors, including tobacco use, obesity, insufficient physical activity, and human papilloma virus (HPV) infection, contribute to the risk for developing cancer, and differences in cancer incidence indicate differences in the prevalence of these risk factors. These differences can be reduced through policy approaches such as the Affordable Care Act, which could increase access for millions of persons to appropriate and timely cancer preventive services, including help with smoking cessation, cancer screening, and vaccination against HPV.
Full Text Available Nosocomial infections which are considered as the primary indicator of the quality of care in hospitals, cause to prolong hospitalization at intensive care unit and hospital, increase morbidity, mortality, and the cost of treatment. Although only 5-10% of the patients are treated in the intensive care units, 20-25% of all nosocomial infections are seen in these units. Preventing nosocomial infections in intensive care units is a process started at the patient acceptance to unit that requires an interdisciplinary team approach of intensive care staffs’ and Infection Control Committee members.Intensive care nurses who are in constant contact with patients have important responsibilities in preventing nosocomial infections. Intensive care nurses should be aware that the nosocomial infections can be prevented. They should have current knowledge about universal precautions related to prevention and control of infections, which are accepted by the entire world and they reinforce this knowledge by practice and should provide the most effective care to patients.In this article, nursing practices for prevention of nosocomial infections in intensive care units are discussed based on universal precautions.
Full Text Available The article is based on research conducted over the period 1993 to 1996 in the Cape Peninsula. The purpose of the study was to determine the contribution of unit managers towards the training of student nurses coming to their units for clinical practice. The sample consisted of student nurses training in the four nursing colleges in the Cape Peninsula, and the unit managers working in the health services accommodating students for clinical practice in the same area. The findings revealed that the majority of unit managers were teaching students whenever they had the opportunity. Generally unit managers were prepared for their teaching function, but many students were not satisfied with some clinical learning opportunities presented to them, for example drawing up patient care plans, discussing patients’ treatment plans when handing over report, giving assistance regarding care decisions and lending support when students are confronted with patient care problems. There appears to be a need to educate unit managers regarding these and other aspects of the students’ training programme.
Troskie, R; Guwa, S N; Booyens, S W
The article is based on research conducted over the period 1993 to 1996 in the Cape Peninsula. The purpose of the study was to determine the contribution of unit managers towards the training of student nurses coming to their units for clinical practica. The sample consisted of student nurses training in the four nursing colleges in the Cape Peninsula, and the unit managers working in the health services accommodating students for clinical practica in the same area. The findings revealed that the majority of unit managers were teaching students whenever they had the opportunity. Generally unit managers were prepared for their teaching function, but many students were not satisfied with some clinical learning opportunities presented to them, for example drawing up patient care plans, discussing patients' treatment plans when handing over report, giving assistance regarding care decisions and lending support when students are confronted with patient care problems. There appears to be a need to educate unit managers regarding these and other aspects of the students' training programme.
... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Possession of the United States. 404.1093... Income § 404.1093 Possession of the United States. In using the exclusions from gross income provided under section 931 of the Code (relating to income from sources within possessions of the United...
... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Redemption by United States. 400.5-1 Section... by United States. (a) Scope. The purpose of this section is to prescribe rules with respect to the provisions contained in section 7425(d), relating to redemption of real property by the United...
... United States Sentencing Commission is an independent agency in the judicial branch of the United States..., and judicial branches of government, and other interested parties, to study the manner in which United... might be appropriate in light of the information obtained from that study. (12) Resolution of...
Denman-Vitale, S; Murillo, E K
Across the United States, advance practice nurses (APNs) are increasingly encountering recently immigrated Latin American populations. This article provides an overview of the situation of Latin Americans in the United States and discusses aspects of Latin American culture such as, respeto (respect), confianza (confidence), the importance of family, and the value of a personal connection. Strategies that will assist practitioners to incorporate culturally holistic principles in the promotion of breastfeeding among Latin American women who are new arrivals in the United States are described. If practitioners are to respond to the increasing numbers of Latin American women who need health care services, and also provide thorough, holistic health care then health care activities must be integrated with cultural competence.
Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis
Morgan Perri A
Full Text Available Abstract Background Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA has been a frontrunner in the use of nurse practitioners (NPs and physician assistants (PAs. Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. Methods This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician. Results NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. Conclusions This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.
Electronic health records (EHR) support clinical management, administration, quality assurance, research, and service planning. The aim of this study was to evaluate a clinical data management programme to improve consistency, completeness and accuracy of EHR information in a large primary care centre with 10 General Practitioners (GPs). A Clinical Data Manager was appointed to implement a Data Management Strategy which involved coding consultations using ICPC-2 coding, tailored support and ongoing individualised feedback to clinicians. Over an eighteen month period there were improvements in engagement with and level of coding. Prior to implementation (August 2011) 4 of the 10 GPs engaged in regular coding and 69% of their consultation notes were coded. After 12 months, all 10 GPs and 6 nurses were ICPC-2 coding their consultations and monthly coding levels had increased to 98%. This structured Data Management Strategy provides a feasible sustainable way to improve information management in primary care.
The Central United States experienced record-setting flooding during 2011, with floods that extended from headwater streams in the Rocky Mountains, to transboundary rivers in the upper Midwest and Northern Plains, to the deep and wide sand-bedded lower Mississippi River. The U.S. Geological Survey (USGS), as part of its mission, collected extensive information during and in the aftermath of the 2011 floods to support scientific analysis of the origins and consequences of extreme floods. The information collected for the 2011 floods, combined with decades of past data, enables scientists and engineers from the USGS to provide syntheses and scientific analyses to inform emergency managers, planners, and policy makers about life-safety, economic, and environmental-health issues surrounding flood hazards for the 2011 floods and future floods like it. USGS data, information, and scientific analyses provide context and understanding of the effect of floods on complex societal issues such as ecosystem and human health, flood-plain management, climate-change adaptation, economic security, and the associated policies enacted for mitigation. Among the largest societal questions is "How do we balance agricultural, economic, life-safety, and environmental needs in and along our rivers?" To address this issue, many scientific questions have to be answered including the following: * How do the 2011 weather and flood conditions compare to the past weather and flood conditions and what can we reasonably expect in the future for flood magnitudes?
Franklin, S.B.; Faber-Langendoen, D.; Jennings, M.; Keeler-Wolf, T.; Loucks, O.; Peet, R.; Roberts, D.; McKerrow, A.
The Federal Geographic Data Committee (FGDC) Vegetation Subcommittee, the Ecological Society of America Panel on Vegetation Classification, and NatureServe have worked together to develop the United States National Vegetation Classification (USNVC). The current standard was accepted in 2008 and fosters consistency across Federal agencies and non-federal partners for the description of each vegetation concept and its hierarchical classification. The USNVC is structured as a dynamic standard, where changes to types at any level may be proposed at any time as new information comes in. But, because much information already exists from previous work, the NVC partners first established methods for screening existing types to determine their acceptability with respect to the 2008 standard. Current efforts include a screening process to assign confidence to Association and Group level descriptions, and a review of the upper three levels of the classification. For the upper levels especially, the expectation is that the review process includes international scientists. Immediate future efforts include the review of remaining levels and the development of a proposal review process.
Ashley, Walker S.; Mote, Thomas L.
Convectively generated wind-storms occur over broad temporal and spatial scales; however, the more widespread and longer lived of these windstorms have been given the name "derecho." Utilizing an integrated derecho database, including 377 events from 1986 to 2003, this investigation reveals the amount of insured property losses, fatalities, and injuries associated with these windstorms in the United States. Individual derechos have been responsible for up to 8 fatalities, 204 injuries, forest blow-downs affecting over 3,000 km2 of timber, and estimated insured losses of nearly a $500 million. Findings illustrate that derecho fatalities occur more frequently in vehicles or while boating, while injuries are more likely to happen in vehicles or mobile homes. Both fatalities and injuries are most common outside the region with the highest derecho frequency. An underlying synthesis of both physical and social vulnerabilities is suggested as the cause of the unexpected casualty distribution. In addition, casualty statistics and damage estimates from hurricanes and tornadoes are contrasted with those from derechos to emphasize that derechos can be as hazardous as many tornadoes and hurricanes.
Victor C. de Munck
Full Text Available We seek to advance cultural models theory by contributing to issues related to theory, methods, and testing the external validity of a cultural model. We propose that cultural models are learned as if they were truly properties of collectivities but have no primary existence except in individual representations of them. The shared aspect of cultural models also implies collective awareness of the if–then entailments of cultural models. We use inductive ethnographic methods of freelisting (n = 80 and pile sorting (n = 39 to derive a cultural model of romantic love in the United States. From these tasks, we developed a cultural model of successful romantic love consisting of normative scenarios. For successful romantic love relations, a person would feel excited about meeting their beloved; make passionate and intimate love as opposed to only physical love; feel comfortable with the beloved, behaving in a companionable, friendly way with one’s partner; listen to the other’s concerns, offering to help out in various ways if necessary; and, all the while, keeping a mental ledger of the degree to which altruism and passion are mutual. Our model is supported through an examination of two extended case studies. Further research is required, of course, but we believe we have a rather novel and dynamic cultural model that is falsifiable and predictive of successful love relationships. The model is unique in that it combines passion with comfort and friendship as properties of romantic love.
John E McDonough
Full Text Available In 2010, the United States adopted its first-ever comprehensive set of health system reforms in the Affordable Care Act (ACA. Implementation of the law, though politically contentious and controversial, has now reached a stage where reversal of most elements of the law is no longer feasible. The controversial portions of the law that expand affordable health insurance coverage to most U.S. citizens and legal residents do not offer any important lessons for the global community. The portions of the law seeking to improve the quality, effectiveness, and efficiency of medical care as delivered in the U.S., hold lessons for the global community as all nations struggle to gain greater value from the societal resources they invest in medical care for their peoples. Health reform is an ongoing process of planning, legislating, implementing, and evaluating system changes. The U.S. set of delivery system reforms has much for reformers around the globe to assess and consider.
Berg, L.L.; Baird, L.M.; Varanini, E.E. III (eds.)
This volume examines the economic, political, and social implications of the oil-dependence dilemma facing the United States. Most of the contributors are energy consultants in the public or private sector. Their analyses of the changing oil situation and its impact on other energy policies reflect either an international, national, or regional perspective with a unique combination of pragmatic insights and academic analyses of these complex issues. While examining the various aspects of the energy dependence dilemma presented here, one critical theme will probably recur to the reader. That is, given the inadequate nature of the US response to the 1973 and 1979 shortfalls in foreign oil supplies, how will we manage the projected future shortages in foreign oil supplies. The 18 papers of this volume were presented at a conference at Los Angeles in July 1980 and cosponsored by the University of Southern California and the California Energy Commission; a separate abstract was prepared for each paper. See also EAPA 7:3231 and Energy Research Abstracts (ERA) 6:18036.
Hakkert, R; Aguirre, E J
Although the popular North American opinion of Mexico is one that paints a picture of a poor, disadvantaged country, South America sees Mexico has a richer more prosperous nation. It is observed that only in the Latin American countries of Venezuela, Suriname and Trinidad and Tobago do consumers have higher incomes than Mexican consumers. Moreover, while millions of Mexicans migrate to the United States to seek a better standard of living, several thousand Central American refugees illegally migrate to Mexico in search of a better life. This better life includes an increased age of lie expectancy from 51 years in the 1950s to 64 years in the late 1970s. There have also been improvements in health care and school enrollments and in the low cost availability of education. Tourism and the prospect of the manufacturing of energy are significant, positive factors working in favor of an improved Mexican economy and a higher overall quality of life. However, Mexico faces serious problems such as a mounting foreign debt. Also rising is Mexico's population which has doubled since 1964 and which continues to grow at a rate of 1.9%. Economic programs and reforms and family development planning have been instituted in response to the countries' current recession and population growth and have begun to show positive results.
Full Text Available This article examines the role of United States holocaust museums in directing (American knowledge and memory of World War II, and demonstrates how signifiers of race, colour and Jewishness are played out and theatricalised. Erected in two principal U.S. cities of Los Angeles and Washington, D.C., the Holocaust Museum and Museum of Tolerance uphold very different mandates: the first dedicated to revealing European civilian tragedies during WWII; the latter dealing with Jewish persecution and the L.A. Riots of 1991, with references to other cultural catastrophes. While these projects are different, they are not opposed; both museums locate the American perspective of events and their meanings at the forefront. American holocaust museums seem to challenge spaces between memory and its direction, vision and revision. Within the gruesome context of holocaust portrayal, interrogate the valences of memory’s play and expose American holocaust museums as theatres of pornographic memory. The seduction of feeling does not invite change so much as purgation, what Aristotle identified as catharsis — an emotional and physical release, unfortunately replicating the seductive techniques used by Goebbels for the glorification of Hitler. Through manipulation of viewers as automatic audiences, these museums function as centres for pathos I question the policy and polity of presenting genocide as an entertainment leading to catharsis, recognizing that the final act of purgation is all too easily negation.
National-scope environmental life cycle models of goods and services may be used for many purposes, not limited to quantifying impacts of production and consumption of nations, assessing organization-wide impacts, identifying purchasing hot spots, analyzing environmental impacts of policies, and performing streamlined life cycle assessment. USEEIO is a new environmentally extended input-output model of the United States fit for such purposes and other sustainable materials management applications. USEEIO melds data on economic transactions between 389 industry sectors with environmental data for these sectors covering land, water, energy and mineral usage and emissions of greenhouse gases, criteria air pollutants, nutrients and toxics, to build a life cycle model of 385 US goods and services. In comparison with existing US input-output models, USEEIO is more current with most data representing year 2013, more extensive in its coverage of resources and emissions, more deliberate and detailed in its interpretation and combination of data sources, and includes formal data quality evaluation and description. USEEIO was assembled with a new Python module called the IO Model Builder capable of assembling and calculating results of user-defined input-output models and exporting the models into LCA software. The model and data quality evaluation capabilities are demonstrated with an analysis of the environmental performance of an average hospital in the US. All USEEIO f
Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1996, the wholesale trade market totaled 2.3 trillion kilowatthours, over 73% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1996 (ELECTRA), is the sixth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1996. The electric trade data collected and presented in this report furnish important information on the wholesale structure found within the US electric power industry. The patterns of interutility trade in the report support analyses of wholesale power transactions and provide input for a broader understanding of bulk power market issues that define the emerging national electric energy policies. The report includes information on the quantity of power purchased, sold, exchanged, and wheeled; the geographical locations of transactions and ownership classes involved; and the revenues and costs. 1 fig., 43 tabs.
Gunn, Charles R.
The United States will rely on five orbital transfer vehicles to carry spacecraft to higher energy orbits than achievable by the Space Shuttle or various Expendable Launch Vehicles (ELV). These vehicles are the Payload Assist Module-Delta (PAM-D), an upgraded version designated PAM-DII, the Inertial Upper Stage (IUS), the Transfer Orbit Stage (TOS), and the Orbital Maneuvering Vehicle (OMV). Development of these vehicles have evolved through contrasting cultures of government and commercial management. The spectrum of their capabilities range from providing spacecraft with only a preprogrammed perigee velocity additions to man-in-the-loop remote controlled spacecraft rendezvous, docking, retrieval and return to a space base; either the Shuttle or the Space Station Freedom. The PAM-D, PAM-DII, and IUS are now nearing maturity. Their characteristics, flight record, costs, and projected future uses are defined. The TOS and OMV are currently in development with first uses scheduled in 1992 and 1993, respectively. The TOS is being commercially developed while the OMV is government developed. The TOS and OMV capabilities, constraints, and costs are reviewed.
The Russian - United States Environmental Restoration Workshop, held in Washington, D.C., and Richland, Washington, from April 5 through 18, 1993, was the first extended collaborative information exchange between the US Department of Energy (DOE) and Russian scientists at the site level. In addition to the Russian scientists, workshop participants included scientists and staff from DOE, Pacific Northwest Laboratory (PNL), Westinghouse Hanford Company (WHC), the US Environmental Training Institute (USETI), universities, and the private sector. The first week (April 5 through 10) of the workshop took place in Washington, D.C., where the Russian and US participants were presented with a US perspective on environmental restoration and remediation issues from representatives in DOE and the US Environmental Protection Agency (EPA). The second week (April 11 through 18) occurred in Richland, Washington, where the participants were presented with site-specific environmental restoration and remediation issues related to Hanford Site cleanup. This report is a compilation of the presentations, discussions, and experiences shared during the second week of the workshop in Richland, Washington.
Clarke, Elizabeth; Diers, Donna; Kunisch, Judith; Duffield, Christine; Thoms, Debra; Hawes, Sue; Stasa, Helen; Fry, Margaret
An interim evaluation was conducted on the professional development components of the New South Wales (NSW) Health 'take the lead' ('ttl') programme, an initiative aimed at enhancing nursing/midwifery unit managers' (N/MUM) skills. Previous research has highlighted the importance of strong nurse leaders, and shown that training programmes may assist in improving leadership skills. The NSW Nursing and Midwifery Office (NaMO) developed the 'ttl' programme for N/MUMs with the intention of improving hospital quality by strengthening nurse leadership. The programme had three strands, with the professional development modules a key component. Semi-structured interviews were conducted with 17 participants who had completed components of the 'ttl' programme. The interviews explored participants' perceptions of the programme, and suggestions for improvement. Qualitative analysis was conducted on the transcribed interviews. The N/MUMs reported feeling increasingly empowered, knowledgeable and supported as a result of attending the 'ttl' workshops. The results suggest that the studied components of the 'ttl' programme may be effective in assisting nurse leaders gain new leadership skills and institute positive changes in the nursing work environment. Leadership programmes such as 'ttl' may provide an effective tool for improving N/MUM performance and role confidence. © 2011 Blackwell Publishing Ltd.
The metaphor of host and guest has value for exploring the practice and role identity of nurses on inpatient mental health units. Two complementary texts, one from the ancient Zen record of Lin-chi, and the other from the contemporary hermeneutic philosopher Richard Kearney, are used to elaborate meanings of host and guest that can be applied to the situation of mental health nurses. In a doctoral study with a hermeneutic design, I addressed the topic of nurse-patient relationship using an interpretive framework that included sources from Buddhist thought. The positions of host and guest emerged from interviews with nurses as one interpretive theme to open up new understanding of the topic. The two texts, originally distant in era and culture, both employ the host and guest metaphor. They are applied to extracts from interviews to open up discussions of hierarchy, status, patients' perspectives, otherness and resistances as features of nurses' complex experience. These provide insights into understanding practice and suggest implications for how institutional environments shape practice. An intercultural reading of texts can provide a source of new understanding of nurse-patient relationships. © 2014 John Wiley & Sons Ltd.
Armando dos Santos Trettene
Full Text Available Abstract OBJECTIVE To assess the nursing workload (NW in Semi-intensive Therapy Unit, specialized in the care of children with Craniofacial anomalies and associated syndromes; to compare the amount of workforce required according to the Nursing Activities Score (NAS and the COFEN Resolution 293/04. METHOD Cross-sectional study, whose sample was composed of 72 patients. Nursing workload was assessed through retrospective application of the NAS. RESULTS the NAS mean was 49.5%. Nursing workload for the last day of hospitalization was lower in patients being discharged to home (p<0.001 and higher on the first compared to last day of hospitalization (p< 0.001. The number of professionals required according to NAS was superior to the COFEN Resolution 293/04, being 17 and 14, respectively. CONCLUSION the nursing workload corresponded to approximately 50% of the working time of nursing professional and was influenced by day and outcome of hospitalization. The amount of professionals was greater than that determined by the existing legislation.