Science.gov

Sample records for advanced nursing directives

  1. Advanced Nursing Directives: Integrating Validated Clinical Scoring Systems into Nursing Care in the Pediatric Emergency Department

    PubMed Central

    deForest, Erin Kate; Thompson, Graham Cameron

    2012-01-01

    In an effort to improve the quality and flow of care provided to children presenting to the emergency department the implementation of nurse-initiated protocols is on the rise. We review the current literature on nurse-initiated protocols, validated emergency department clinical scoring systems, and the merging of the two to create Advanced Nursing Directives (ANDs). The process of developing a clinical pathway for children presenting to our pediatric emergency department (PED) with suspected appendicitis will be used to demonstrate the successful integration of validated clinical scoring systems into practice through the use of Advanced Nursing Directives. Finally, examples of 2 other Advanced Nursing Directives for common clinical PED presentations will be provided. PMID:22778944

  2. Knowledge, attitudes, and predictors of advance directive discussions of registered nurses.

    PubMed

    Lipson, Amy R; Hausman, Alice J; Higgins, Patricia A; Burant, Christopher J

    2004-11-01

    The purpose of this study was to describe nurses' knowledge, attitudes, and experiences regarding advance directives. A secondary purpose was to examine predictors of advance directive discussions between nurses and patients. Seven-hundred and nineteen respondents, randomly selected from a list of registered nurses in the state of Ohio, completed mailed questionnaires. Descriptive t test, chi-square, and logistic regression statistics were used in the data analyses. The respondents were knowledgeable and possessed positive attitudes about advance directives. Higher self-perceived confidence in advance directive discussion skills and the experience of caring for at least one patient with a current advance directive were found to be significant predictors of advance directive discussions. These findings suggest that experience with advance directives documents is critical for nurses' comfort and that developing interventions to further nurses' confidence in their discussion skills may increase advance directive discussions.

  3. Primary healthcare NZ nurses' experiences of advance directives: understanding their potential role.

    PubMed

    Davidson, Raewyn; Banister, Elizabeth; de Vries, Kay

    2013-07-01

    Advance directives are one aspect of advance care planning designed to improve end of life care. The New Zealand Nurses Organisation released their first mission statement in 2010 concerning advance directives suggesting an increase in the use of these. A burgeoning older population, expected to rise over the next few years, places the primary healthcare nurse in a pivotal role to address the challenges in constructing advance directives. While literature supports the role for primary healthcare nurses in promoting advance directives, no research was found on this role in the New Zealand context. This paper presents results of a qualitative study conducted in New Zealand with 13 senior primary healthcare nurses with respect to their knowledge, attitudes, and experiences of advance directives. Results of the analysis revealed a dynamic process involving participants coming to understand their potential role in this area. This process included reflection on personal experience with advance directives; values and ethics related to end of life issues; and professional actions.

  4. Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives

    ERIC Educational Resources Information Center

    Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.

    2003-01-01

    Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…

  5. Origination of Medical Advance Directives Among Nursing Home Residents With and Without Serious Mental Illness

    PubMed Central

    Cai, Xueya; Cram, Peter; Li, Yue

    2013-01-01

    Objective Nursing home residents with serious mental illness need a high level of general medical and end-of-life services. This study tested whether persons with serious mental illness are as likely as other nursing home residents to make informed choices about treatments through medical advance care plans. Methods Secondary analyses were conducted with data from a 2004 national survey of nursing home residents with serious mental illness (N=1,769) and without (N=11,738). Bivariate and multivariate analyses determined differences in documented advance care plans, including living wills; “do not resuscitate” and “do not hospitalize” orders; and orders concerning restriction of feeding tube, medication, or other treatments. Results The overall rates of having any of the four advance care plans were 57% and 68% for residents with and without serious mental illness, respectively (p<.001). Residents with serious mental illness also showed lower rates for individual advance care plans. In a multivariate analysis that adjusted for resident and facility characteristics (N=1,174 nursing homes) as well as survey procedures, serious mental illness was associated with a 24% reduced odds of having any advance directives (adjusted odds ratio=.76, 95% confidence interval=.66–.87, p<.001). Similar results were found for individual documented plans. Conclusions Among U.S. nursing home residents, those with serious mental illness were less likely than others to have written medical advance directives. Future research is needed to help understand both resident factors (such as inappropriate behaviors, impaired communication skills, and disrupted family support) and provider factors (including training, experience, and attitude) that underlie this finding. PMID:21209301

  6. Perceptions of North Dakota Registered Nurses Regarding Advance Directives

    DTIC Science & Technology

    2005-05-01

    directives as affecting their management of care (Langerman et al., 2000). A recent study that reviewed the charts of patients undergoing high -risk...greatly affected by a number of essential concepts, such as perception, time, interaction, role, power, status, comfort level, and decision-making. This...directives for themselves reflected the low national averages. Finally, the majority of participants reported encountering multiple barriers to discussing

  7. Advanced urology nursing practice.

    PubMed

    Crowe, Helen

    2014-03-01

    Urology nursing has developed as a specialty over the past few decades in response to several factors, workload demands being a prime reason. Nurses are taking on additional roles and activities including procedures such as cystoscopy and prostate biopsy, and running nurse-led clinics for a variety of urological conditions. Audits of advanced urological nursing practice have shown this care to be of a high standard and investigative procedures performed by these nurses match the diagnostic quality of existing services. Professional urological nursing organizations support the professional needs of these nurses, but the provision of education and training for advanced practice activities remains an unaddressed need. A range of confusing advanced urology nursing titles exists, and uncertainty regarding the roles and scope of practice for these nurses remains a concern. Acceptance and support from medical colleagues is required for the success of advanced urological nursing practice, but opinions on these roles remain divided.

  8. A Qualitative Analysis of an Advanced Practice Nurse-Directed Transitional Care Model Intervention

    ERIC Educational Resources Information Center

    Bradway, Christine; Trotta, Rebecca; Bixby, M. Brian; McPartland, Ellen; Wollman, M. Catherine; Kapustka, Heidi; McCauley, Kathleen; Naylor, Mary D.

    2012-01-01

    Purpose: The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). Design and Methods: APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An…

  9. Do Advance Directives Direct?

    PubMed

    Shapiro, Susan P

    2015-06-01

    Resolution of long-standing debates about the role and impact of advance directives - living wills and powers of attorney for health care - has been hampered by a dearth of appropriate data, in particular data that compare the process and outcomes of end-of-life decision making on behalf of patients with and without advance directives. Drawing on a large ethnographic study of patients in two intensive care units in a large urban teaching hospital, this article compares aspects of the medical decision-making process and outcomes by advance-directive status. Controlling for demographic characteristics and severity of illness, the study finds few significant differences between patients without advance directives and those who claim to have them. Surprisingly, these few differences hold only for those whose directives are in their hospital chart. There are no significant differences between those with no directive and those claiming to have a copy at home or elsewhere. The article considers the implications if directives seemingly must be in hand to show even modest effects. Do advance directives direct? The intensive care unit data provide far more support for the growing body of literature that casts doubt on their impact than studies that promote the use of them.

  10. Advance Directives

    MedlinePlus

    ... that reflects your values. Talk to your doctor, nurse, or social worker for advice or help with ... document is legal in 42 states and the District of Columbia, and is available in 26 languages, ...

  11. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

    PubMed

    Coffey, Alice; McCarthy, Geraldine; Weathers, Elizabeth; Friedman, M Isabel; Gallo, Katherine; Ehrenfeld, Mally; Chan, Sophia; Li, William H C; Poletti, Piera; Zanotti, Renzo; Molloy, D William; McGlade, Ciara; Fitzpatrick, Joyce J; Itzhaki, Michal

    2016-06-01

    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.

  12. Education of advanced practice nurses in Canada.

    PubMed

    Martin-Misener, Ruth; Bryant-Lukosius, Denise; Harbman, Patricia; Donald, Faith; Kaasalainen, Sharon; Carter, Nancy; Kilpatrick, Kelley; DiCenso, Alba

    2010-12-01

    In Canada, education programs for the clinical nurse specialist (CNS) and nurse practitioner (NP) roles began 40 years ago. NP programs are offered in almost all provinces. Education for the CNS role has occurred through graduate nursing programs generically defined as providing preparation for advanced nursing practice. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe the following: (1) history of advanced practice nursing education in Canada, (2) current status of advanced practice nursing education in Canada, (3) curriculum issues, (4) interprofessional education, (5) resources for education and (6) continuing education. Although national frameworks defining advanced nursing practice and NP competencies provide some direction for education programs, Canada does not have countrywide standards of education for either the NP or CNS role. Inconsistency in the educational requirements for primary healthcare NPs continues to cause significant problems and interferes with inter-jurisdictional licensing portability. For both CNSs and NPs, there can be a mismatch between a generalized education and specialized practice. The value of interprofessional education in facilitating effective teamwork is emphasized. Recommendations for future directions for advanced practice nursing education are offered.

  13. Advancing leadership capacity in nursing.

    PubMed

    Scott, Elaine S; Miles, Jane

    2013-01-01

    To address the potential shortage of nurse leaders, the profession must evaluate current strategies in both education and practice. While many new graduates dream of becoming a nurse practitioner or nurse anesthetist, few transition into practice with the goal of becoming a nurse leader. To increase the number of nurses capable of leadership, the profession must address 2 critical issues. First, effort must be made to augment faculty and students' conceptualization of nursing such that leadership is seen as a dimension of practice for all nurses, not just those in formal leadership roles. In so doing, leadership identity development would be seen as a part of becoming an expert nurse. Second, a comprehensive conceptual framework for lifelong leadership development of nurses needs to be designed. This framework should allow for baseline leadership capacity building in all nurses and advanced leadership development for those in formal administrative and advanced practice roles. The knowledge and skill requirements for quality improvement and patient safety have been explored and recommendations made for Quality and Safety Education for Nurses, but parallel work needs to be done to outline educational content, objectives, and effective pedagogy for advancing leadership development in nursing students at all levels.

  14. Training Advanced Practice Palliative Care Nurses.

    ERIC Educational Resources Information Center

    Sherman, Deborah Witt

    1999-01-01

    Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)

  15. Advanced care directives

    MedlinePlus

    ... you want no matter how ill you are. Writing an advance care directive may be hard. You ... wishes usually replace those you made previously in writing. Additional Information Write your living will or health ...

  16. Doctoral education for WOC nurses considering advanced practice nursing.

    PubMed

    Pieper, Barbara; Colwell, Janice

    2012-01-01

    Advanced practice nursing education is at a crossroads. Societal changes, increased health care demands, and leadership nursing organizations have identified the need of a doctor of nursing practice (DNP) degree as the advanced practice degree. WOC nurses need to examine DNP programs when considering returning for an advanced practice degree. This article explores nursing education at the doctorate level and areas the WOC nurse should consider when making a decision about attending a program. The WOC nurse needs to understand the similarities and differences of the doctor of philosophy and the DNP, issues about each program and its completion, personal factors, and the application process. Although selecting a doctoral program is a daunting experience, the education will provide opportunities for the WOC nurse to excel as a scholar, thus influencing the profession and the practice.

  17. Psychiatric Advance Directives: Getting Started

    MedlinePlus

    ... More... Home Getting Started National Resource Center on Psychiatric Advance Directives - Getting Started Getting Started Psychiatric advance directives (PADs) are relatively new legal instruments ...

  18. Story theory: advancing nursing practice scholarship.

    PubMed

    Smith, Mary Jane; Liehr, Patricia

    2005-01-01

    Stories are a fundamental dimension of human experience and nursing practice. Story theory describes a narrative happening that occurs through intentional nurse-person dialogue. Seven inquiry phases are associated with story theory, including gathering the story, reconstructing the story, connecting it to the literature, naming the complicating health challenge, describing the story plot, identifying movement toward resolving, and gathering additional stories. This article describes the use of story theory to advance nursing practice scholarship in both academic and everyday nursing practice.

  19. Infusing gerontological nursing content into advanced practice nursing education.

    PubMed

    Kohlenberg, Eileen; Kennedy-Malone, Laurie; Crane, Patricia; Letvak, Susan

    2007-01-01

    The inclusion of gerontology content in the nursing curriculum is paramount as our population of older adults grows. As one of 10 recipients of the John A. Hartford Foundation/AACN awards for Enhancing Gerontological and Geriatric Nursing Education for Advanced Practice Nursing Programs, we successfully integrated gerontological/ geriatric content throughout core courses for all concentrations taught at the master's level. The Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care were used as a guide to integrate gerontological nursing content across the core courses. We present examples of content, strategies, and evaluation methods that demonstrate infusion of gerontology in a nursing theory course, research course, and healthcare law and policy course. Twenty-two of the competencies are addressed in these core courses and provide a foundation for further development in the support and specialty courses for the nurse practitioner, clinical nurse specialist, nursing administrator, nurse educator, and nurse anesthetist. We also present helpful Web-based resources for older adult care.

  20. Using advanced mobile devices in nursing practice--the views of nurses and nursing students.

    PubMed

    Johansson, Pauline; Petersson, Göran; Saveman, Britt-Inger; Nilsson, Gunilla

    2014-09-01

    Advanced mobile devices allow registered nurses and nursing students to keep up-to-date with expanding health-related knowledge but are rarely used in nursing in Sweden. This study aims at describing registered nurses' and nursing students' views regarding the use of advanced mobile devices in nursing practice. A cross-sectional study was completed in 2012; a total of 398 participants replied to a questionnaire, and descriptive statistics were applied. Results showed that the majority of the participants regarded an advanced mobile device to be useful, giving access to necessary information and also being useful in making notes, planning their work and saving time. Furthermore, the advanced mobile device was regarded to improve patient safety and the quality of care and to increase confidence. In order to continuously improve the safety and quality of health care, advanced mobile devices adjusted for nursing practice should be further developed, implemented and evaluated in research.

  1. Developing the Advanced Practice Nurse in Catalonia.

    PubMed

    Comellas-Oliva, Montserrat

    2016-01-01

    The development of advanced practice nurses (APN) has proved a challenge for nurses in countries such as the USA, Canada, Great Britain, and Australia among others. It is only in recent years that the system has been considered in Catalonia and Spain as a way to develop new roles to bring effectiveness and efficiency to the health system. From the standpoint of training and implementation of the above-mentioned new nursing roles, the following article aims to conceptualise APN and its reference models, as well as to contextualise and reflect on APN in Catalonia in order to assimilate them into advanced practice.

  2. Advanced Practice Nursing Education: Challenges and Strategies

    PubMed Central

    Fitzgerald, Cynthia; Kantrowitz-Gordon, Ira; Katz, Janet; Hirsch, Anne

    2012-01-01

    Nursing education programs may face significant difficulty as they struggle to prepare sufficient numbers of advanced practice registered nurses to fulfill the vision of helping to design an improved US healthcare system as described in the Institute of Medicine's “Future of nursing” report. This paper describes specific challenges and provides strategies to improve advanced practice nursing clinical education in order to ensure that a sufficient number of APRNs are available to work in educational, practice, and research settings. Best practices are identified through a review of classic and current nursing literature. Strategies include intensive interprofessional collaborations and radical curriculum revisions such as increased use of simulation and domestic and international service work. Nurse educators must work with all stakeholders to create effective and lasting change. PMID:22220273

  3. Nursing role complex in advanced HIV care.

    PubMed

    Kutzen, H S

    1998-01-01

    Nurses in AIDS care need to support patients and promote patient autonomy throughout the continuum of HIV/AIDS. Nurses are essential for assisting patients and family members in making difficult treatment decisions, including choices regarding death. Discussions of end of life issues should be postponed until the patient demonstrates active signs and symptoms of approaching death. These discussions require expert knowledge of subtle cues and knowledge of advancing disease, as well as options for improved symptom management without focusing on curative aspects of care. Through these discussions, the nurse empowers the family in decision making while realizing patients and loved ones are still faced with existential or spiritual crises, psychological pain, and grief associated with terminal illness. Towards the end of life, nursing contacts should increase and be armed with an understanding of palliative care planning with patients with advanced HIV disease.

  4. The Career Advancement for Registered Nurse Excellence Program.

    PubMed

    Fusilero, Jane; Lini, Linda; Prohaska, Priscilla; Szweda, Christine; Carney, Katie; Mion, Lorraine C

    2008-12-01

    Nurse administrators focus on factors that influence nurses' levels of satisfaction to reduce turnover and improve retention. One important determinant of nurses' satisfaction is the opportunity for professional development. On the basis of feedback from the nurses, a professional development program, Career Advancement for Registered Nurse Excellence, was instituted. The authors describe one approach to create opportunities to improve professional nurse development and the necessity for ongoing assessment of its impact on nurses' job satisfaction.

  5. The Enigma of Graduate Nursing Education: Advanced Generalist? Specialist?

    ERIC Educational Resources Information Center

    Reed, Suellen B.; Hoffman, Sharon E.

    1986-01-01

    To pin down the appropriate parameters for graduate nursing education, the authors say we must explore the meanings of advanced generalist and specialist. They discuss the focus, scope, and depth of the community health major, psychiatric mental health nursing, nursing care of children, maternity nursing, medical-surgical nursing, and nursing…

  6. Illuminating the clinical nurse specialist role of advanced practice nursing: a qualitative study.

    PubMed

    Canam, Connie

    2005-12-01

    As the advanced practice nursing initiative in Canada gains momentum, effort is being directed towards clarifying and defining advanced practice roles. A qualitative study was undertaken to increase understanding of the clinical nurse specialist role of advanced practice. Sixteen nurses who worked in advanced practice roles, organizing and providing healthcare for children with complex health needs and their families across the continuum of care, participated in in-depth conversations about the nature of their practice, the knowledge that informs it and the factors that influence it. Findings suggest that clinical nurse specialists have a unique role in the organization and delivery of healthcare for specialized populations with complex health needs in their dual focus on the system level of healthcare and on population health needs. Initiatives directed to children and families within the study participants' specialties included program development, consultation and educational outreach and the development of clinical guidelines and policies. Although the nurses described their practice as focusing both on individual children and families and on the population of children and families within their specialty, it is at the population level that they see their greatest potential for contributing to the delivery of high-quality, cost-effective healthcare.

  7. Advanced nursing practice and Newton's three laws of motion.

    PubMed

    Sturgeon, David

    This article considers the reasons for the development of advanced practice roles among nurses and other healthcare professions. It explores the implications of financial constraints, consumer preferences and the development of new healthcare services on the reorganization of professional boundaries. It makes use of Sir Isaac Newton's three laws of motion to demonstrate how professional development in nursing has taken place in response to a number of external influences and demands. It also considers the significance of skill mix for the nursing profession, in particular the development and likely expansion of the physician assistant role. The application of different professionals and grades within a healthcare team or organization is central to the Government's Agenda for Change proposals and nurses have successfully adopted a number of roles traditionally performed by doctors. Nurses have demonstrated that they are capable of providing high quality care and contributing directly to positive patient outcome. Advanced nursing roles should not only reflect the changing nature of healthcare work, they should also be actively engaged in reconstructing healthcare boundaries.

  8. Teaching Research Synthesis to Advanced Practice Nurses.

    ERIC Educational Resources Information Center

    Upchurch, Sandra; Brosnan, Christine A.; Grimes, Deanna E.

    2002-01-01

    A process for teaching research synthesis to advanced practice nurses includes two courses: a first research applications course in which students build bibliographic databases, practice statistical analysis, and develop search skills; and a second course in which they complete literature reviews or meta analyses of research on clinical practice…

  9. National agenda for advanced practice nursing: the practice doctorate.

    PubMed

    Clinton, Patricia; Sperhac, Arlene M

    2006-01-01

    The purpose of this article was to provide the background and rationale for the practice doctorate in nursing. The American Association of Colleges of Nursing's Position Statement on the Practice Doctorate in Nursing, approved in October 2004, will be discussed. Outlined are some of the changes that will be needed in education, regulation, and advanced practice. Common questions and concerns that advanced practice nurses have, including titling, salary, and transitioning to the doctor of nursing practice degree, will be addressed.

  10. Trauma advanced practice nurses: implementing the role.

    PubMed

    Martin, Kathleen D; Molitor-Kirsch, Shirley; Elgart, Heidi; Ruffolo, Daria C; Sicoutris, Corinna; Meredith, Denise

    2004-01-01

    The need for advanced practice nurses (APN) has expanded over the past several decades as a result of the changing healthcare environment. Increased patient acuity and decreased resident work hours have lead to a need for additional clinical expertise at the bedside. APNs are becoming an integral part of the acute care delivery team in many trauma programs and intensive care units. To date little has been published regarding the role of the APN in Trauma Centers. This article outlines the wide variety of responsibilities and services provided by a select group of nurse practitioners who work in trauma centers throughout the United States.

  11. Informatics and Nursing in a Post-Nursing Informatics World: Future Directions for Nurses in an Automated, Artificially Intelligent, Social-Networked Healthcare Environment.

    PubMed

    Booth, Richard G

    2016-01-01

    The increased adoption and use of technology within healthcare and society has influenced the nursing informatics specialty in a multitude of fashions. Namely, the nursing informatics specialty currently faces a range of important decisions related to its knowledge base, established values and future directions - all of which are in need of development and future-proofing. In light of the increased use of automation, artificial intelligence and big data in healthcare, the specialty must also reconceptualize the roles of both nurses and informaticians to ensure that the nursing profession is ready to operate within future digitalized healthcare ecosystems. To explore these goals, the author of this manuscript outlines an examination of technological advancements currently taking place within healthcare, and also proposes implications for the nursing role and the nursing informatics specialty. Finally, recommendations and insights towards how the roles of nurses and informaticians might evolve or be shaped in the growing post-nursing informatics era are presented.

  12. Advanced practice nurse as outcomes manager.

    PubMed

    Houston, S; Luquire, R

    1997-01-01

    Outcomes management as a patient management system has been designed to impact and improve select outcomes. Central to the development and implementation of best practice senario identified throughout outcomes management is the advanced practice nurse. SLEH has been in the forefront of development and implementation of an outcomes management program. This article describes the outcomes management position and shares the job description and performance evaluation used at this institution. The tools allow for measuring and quantifying the impact of the outcomes manager position on improving patient outcomes. The improvement of outcomes has increased the value of the advanced practice nurse and provided the institution with a solid future necessary for survival in a managed care market.

  13. Advancing palliative and end-of-life science in cardiorespiratory populations: The contributions of nursing science.

    PubMed

    Grady, Patricia A

    Nursing science has a critical role to inform practice, promote health, and improve the lives of individuals across the lifespan who face the challenges of advanced cardiorespiratory disease. Since 1997, the National Institute of Nursing Research (NINR) has focused attention on the importance of palliative and end-of-life care for advanced heart failure and advanced pulmonary disease through the publication of multiple funding opportunity announcements and by supporting a cadre of nurse scientists that will continue to address new priorities and future directions for advancing palliative and end-of-life science in cardiorespiratory populations.

  14. Patient safety: honoring advanced directives.

    PubMed

    Tice, Martha A

    2007-02-01

    Healthcare providers typically think of patient safety in the context of preventing iatrogenic injury. Prevention of falls and medication or treatment errors is the typical focus of adverse event analyses. If healthcare providers are committed to honoring the wishes of patients, then perhaps failures to honor advanced directives should be viewed as reportable medical errors.

  15. Advanced practice nursing for congestive heart failure.

    PubMed

    McCormick, S A

    1999-02-01

    Congestive heart failure (CHF) is an enormous burden on society and the health care system. The role of the advanced practice nurse (APN) in CHF is multifaceted and combines inpatient, outpatient, and community patient care skills. Case management and quality management have been traditional focuses, with a high level of practice impact on patient care. Outcomes management in the APN role for CHF care is the future for measurable outcomes and maximum impact on organizational values. Because outcomes management is an evolving field for the APN, focus on a chronic disease such as CHF is a very valuable tool for implementation.

  16. Health Care Providers’ Attitudes and Practices Regarding the use of Advance Directives in a Military Health Care Setting

    DTIC Science & Technology

    2007-11-02

    and skills about advance directives have been cited for low completion rates. Family nurse practitioners ( FNPs ), in both civilian and military settings...receive training on ethical and moral implications of advanced nursing practice. These characteristics make the FNP an ideal candidate for promoting...environment (Hunter et al., 1997). Advanced Nursing Role Family nurse practitioners ( FNPs ) are well suited to initiate conversations concerning end-of-life

  17. The Future of Nursing: Leading Change, Advancing Health

    ERIC Educational Resources Information Center

    National Academies Press, 2011

    2011-01-01

    "The Future of Nursing" explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single…

  18. [The Role of Nursing Education in the Advancement of the Nursing Profession].

    PubMed

    Chang Yeh, Mei

    2017-02-01

    The present article discusses the role of nursing education in the advancement of the nursing profession in the context of the three facets of knowledge: generation, dissemination, and application. Nursing is an applied science and the application of knowledge in practice is the ultimate goal of the nursing profession. The reform of the healthcare delivery model requires that nurses acquire and utilize evidence-based clinical knowledge, critical thinking, effective communication, and team collaboration skills in order to ensure the quality of patient care and safety. Therefore, baccalaureate education has become the minimal requirement for pre-licensure nursing education. Schools of nursing are responsible to cultivate competent nurses to respond to the demands on the nursing workforce from the healthcare system. Attaining a master's education in nursing helps cultivate Advanced Practice Registered Nurses (APRNs) to further expand the roles and functions of the nursing profession in order to promote the quality of care in clinical practice. Nursing faculty and scholars of higher education institutions generate nursing knowledge and develop professional scholarship through research. Attaining a doctoral education in nursing cultivates faculties and scholars who will continually generate and disseminate nursing knowledge into the future.

  19. Developing practice protocols for advanced practice nursing.

    PubMed

    Paul, S

    1999-08-01

    In most states, the role of an advanced practice nurse is dependent on practice protocols that provide an organized method for analyzing and managing a disease or major symptom. They are also used to control the process of medical care and to specify steps in the delivery of that care. Creating appropriate practice protocols is one of the most important precursors to implementing the advanced practice role, because they virtually drive the clinician's ability to treat or manage clinical situations or disease states. This article outlines the steps involved in developing practice protocols and discusses the content that should be included in a protocol, providing an example of narrative and algorithm format protocols. Pros and cons, as well as legal issues related to practice protocols, are also presented.

  20. Teaching Pediatric Nursing Concepts to Non-Pediatric Nurses Using an Advance Organizer

    ERIC Educational Resources Information Center

    Bell, Julie Ann

    2013-01-01

    Non-pediatric nurses in rural areas often care for children in adult units, emergency departments, and procedural areas. A half-day program about pediatric nursing using constructivist teaching strategies including an advance organizer, case studies, and simulation was offered at a community hospital in Western North Carolina. Nurses reported a…

  1. Role of advanced paediatric nurse practitioners.

    PubMed

    Lisa, Egerton

    2012-07-01

    Children's attendance at emergency departments (EDs) is increasing every year, yet many children present with minor, self-limiting illnesses that could be managed at home. In light of Williams et al (2009) suggestion that healthcare professionals should improve the care available to patients at point of contact rather than try to change their health-seeking behaviours, this article describes how Tameside and Glossop Primary Care Trust has developed an advanced paediatric nurse practitioner (APNP) service in the ED to improve the care of children, and to reduce the number of admissions. The APNPs treat children in the ED then divert them to more appropriate services where support is given to the families to care for their children at home. The role contributes to meeting ED clinical quality indicators, frees up medical staff to deal with more seriously ill patients, and makes financial savings for the trust.

  2. Advanced practice geriatric nursing education. New options in Kansas.

    PubMed

    Bonnel, W B

    1999-01-01

    Knowledgeable practitioners with the skills needed to serve in a variety of clinical settings are the primary objective of the Adult-Geriatric Advanced Nursing Program and the FNP elective, Advanced Practice Nursing Care of the Frail Elderly. The continued blending of long term and acute care settings will further cloud and challenge the school responsible for educating APNs in the care of older adults, particularly the frail elderly. Education needs to provide flexibility for students through new service designs such as interactive computer courses. Nurses with an orientation to the future should consider geriatric nursing education.

  3. Ethics and the politics of advancing nursing knowledge.

    PubMed

    Milton, Constance L

    2015-04-01

    The politics of academia involve intricate human relationships that are political in nature as nurse leaders and scholars struggle to advance nursing science with complex leading-following situations. This article begins a dialogue of considering potential meanings for what it means to be political within competing interest groups in academia, and within the discipline of nursing. What is most important in the struggle for identity and what possibilities surface when potential competing interests in academia collide? The ethical tenets of humanbecoming and the leading-following model are used to illustrate issues surrounding academic integrity and possibilities for the advancement of nursing scholarship in future generations.

  4. Direct costs of dementia in nursing homes

    PubMed Central

    Caravau, Hilma; Martín, Ignacio

    2015-01-01

    Dementia represents an economical burden to societies nowadays. Total dementia expenses are calculated by the sum of direct and indirect costs. Through the stages of the diseases, as the patients may require institutionalization or a formal caregiver, the direct costs tend to increase. This study aims to analyze the direct costs of dementia in Portuguese nursing homes in 2012, compare the spending between seniors with and without dementia, and propose a predictive costs model. The expenses analysis was based on (1) the use of emergency rooms and doctor's appointments, either in public or private institutions; (2) days of hospitalization; (3) medication; (4) social services use; (5) the need for technical support; and (6) the utilization of rehabilitation services. The sample was composed of 72 people, half with dementia and half without. The average annual expense of a patient with dementia was €15,287 thousand, while the cost of a patient without dementia was about €12,289 thousand. The variables “ability to make yourself understood,” “self-performance: getting dressed” and “thyroid disorders” were found to be statistically significant in predicting the expenses' increase. In nursing homes, in 2012, the costs per patient with dementia were 1, 2 times higher than per patient without dementia. PMID:26283959

  5. Transnational nurse migration: future directions for medical anthropological research.

    PubMed

    Prescott, Megan; Nichter, Mark

    2014-04-01

    Transnational nurse migration is a serious global health issue in which inequitably distributed shortages hinder health and development goals. This article selectively reviews the literature on nurse migration that has emerged from nursing, health planning, and the social sciences and offers productive directions for future anthropological research. The literature on global nurse migration has largely focused on push/pull economic logic and the concept of brain drain to understand the causes and effects of nurse migration. These concepts obscure political-economic, historical, and cultural factors that pattern nurse migration and influence the complex effects of nurse migration. Global nurse care chain analysis helps illuminate the numerous nodes in the production and migration of nurses, and management of this transnational process. Examples are provided from the Philippines and India to illustrate ways in which this analysis may be deepened, refined and rendered more critical by anthropological research.

  6. Enhancing nursing practice by utilizing voice recognition for direct documentation.

    PubMed

    Fratzke, Jason; Tucker, Sharon; Shedenhelm, Heidi; Arnold, Jackie; Belda, Tom; Petera, Michael

    2014-02-01

    Innovative strategies that preserve nursing time for direct patient care activities are needed. This study examined the utility, feasibility, and acceptability of voice recognition (VR) software to document nursing care and patient outcomes in an electronic health record in a simulated nursing care environment. A phase 1 trial included 5 iterative experiments with observations and nurse participant feedback to allow enhancements to the speech detection capabilities and refinement of the technology, software, and processes. Utility ratings improved over time; however, interference on nursing care remained a concern throughout. Nurse participants favored keyboard entry electronic health record, largely due to software and technical issues, but also relative to the culture shift the new technology brings to nursing practice. Successful adoption of VR technology by nursing will be dependent on receptiveness of the nurses and perceived benefits, timely access to education and training, and minimization of barriers to using the software.

  7. Defining features of advance directives in law and clinical practice.

    PubMed

    Olick, Robert S

    2012-01-01

    In the > 30 years since the New Jersey Supreme Court's seminal opinion in the case of Karen Ann Quinlan, all 50 states and the District of Columbia have enacted legislation to recognize the legal right of competent adults to write advance directives. The purpose of advance directives is to provide direction for health-care decisions near the end of life, when the ravages of illness, disease, or injury have taken the ability to decide for one's self. This article reviews the defining features of advance directives and the governing law, discusses some common practical concerns regarding the use and effectiveness of advance directives, and identifies several significant ethical-legal challenges for honoring advance directives at the bedside. With a primary focus on the health-care proxy, the anatomy of advance directives is analyzed under four general rubrics: formal requirements, decisional capacity and when the directive takes effect, rights and responsibilities of proxies and health-care providers, and the scope and limitations of decisions to forego life-sustaining treatment. There is much common ground among state laws, but particular legal provisions may vary from state to state. Physicians, nurses, social workers, and other health-care professionals should be familiar with the law of their home state.

  8. Nursing work in NHS Direct: constructing a nursing identity in the call-centre environment.

    PubMed

    Snelgrove, Sherrill Ray

    2009-12-01

    The introduction of nurse-led telephone helplines for patients to have access to information and advice has led to the development of a new kind of practise for nurses. This study focuses on the ways NHS Direct (NHSD) nurses construct a nursing identity and shape their work in a call-centre environment. The empirical findings are drawn from a study investigating the impact of NHSD on professional nursing issues that was part of a wider evaluation of the service in South Wales, UK. Data were gathered from responses to free text questions included in a questionnaire sent to nurses in three NHSD sites. Further data were collected from focus groups held with NHSD nurses. The nurses defend their identity as nurses rather than call-centre workers. The discourses of the nurses show a strong alignment with the traditional values of nursing, encompassing holistic and empathetic practise that has moved with the nurses across locales. We argue that the nurses frame a nursing identity in NHSD around the importance of previous experience and claim to practise holistic nursing. However, the development of new skills and adaptation of old skills in response to the demand of NHSD work challenges normative notions of traditional 'hands-on' models of practise and indicates a possible movement towards a cognitive model of nursing based upon knowledge, analytical and communication skills that reflects the transformative and dynamic nature of professional identity and boundaries.

  9. An Infrastructure to Advance the Scholarly Work of Staff Nurses

    PubMed Central

    Parkosewich, Janet A.

    2013-01-01

    The traditional role of the acute care staff nurse is changing. The new norm establishes an expectation that staff nurses base their practice on best evidence. When evidence is lacking, nurses are charged with using the research process to generate and disseminate new knowledge. This article describes the critical forces behind the transformation of this role and the organizational mission, culture, and capacity required to support practice that is based on science. The vital role of senior nursing leaders, the nurse researcher, and the nursing research committee within the context of a collaborative governance structure is highlighted. Several well-known, evidence-based practice models are presented. Finally, there is a discussion of the infrastructure created by Yale-New Haven Hospital to advance the scholarly work of the nursing staff. PMID:23482435

  10. Broadening horizons: engaging advanced practice nursing students in faculty research.

    PubMed

    Weiss, Josie A

    2009-01-01

    Inviting advanced practice nursing students to participate in faculty research can be an innovative way to interest students in using current evidence as the basis for their practice. The author discusses strategies for effectively engaging graduate nursing students into research projects in ways that broaden the students' perspectives and strengthen their healthcare decision-making skills.

  11. Role ambiguity in nursing: undergraduate students' struggle for direction.

    PubMed

    Gagan, Alex

    2002-06-01

    An experience common to many undergraduate nursing students, particularly whilst on placement in the clinical area, is a sense of aimlessness, lack of direction and standard role, and an overall ambiguity about what nursing is and does. Research in the nursing literature contributes to and supports the concept of the lack of clarity of the nursing role. Whilst the discourse of nursing is diverse and covers many aspects of nursing, a number of core issues may be seen to emerge. These contribute to form a concept that may be identified as the ambiguity of nursing. This paper identifies those issues and represents this concept of role ambiguity. These issues include the concept of caring and the apparent lack of clarity over what this actually is in a nursing context.

  12. Advancing the educational and career pathway for clinical trials nurses.

    PubMed

    Scott, Kathleen; White, Kathryn; Roydhouse, Jessica K

    2013-04-01

    Clinical trials nurses play a pivotal role in the conduct of clinical research, but the educational and career pathway for these nurses remains unclear. This article reports findings from a survey of nurses working in cancer clinical trials research in Australia. Most participants held postgraduate qualifications (42 of 61); however, clinical trials education was primarily attained through short professional development courses. Interest in pursuing trial-specific postgraduate education was high, but barriers were identified, including cost, time, and unclear benefit for career advancement. Job titles varied substantially, which is indicative of an unclear employment pathway. These findings suggest that initiatives to improve the educational and career pathway for clinical trials nurses are needed and should include the following: formal educational preparation, greater consistency in employment status, and clearer career progression. These strategies should be underpinned by broad professional recognition of the clinical trials nurse as a specialized nursing role.

  13. Skills Required for Nursing Career Advancement: A Qualitative Study

    PubMed Central

    Sheikhi, Mohammad Reza; Fallahi-Khoshnab, Masoud; Mohammadi, Farahnaz; Oskouie, Fatemeh

    2016-01-01

    Background Nurses require certain skills for progression in their field. Identifying these skills can provide the context for nursing career advancement. Objectives This study aimed to identify the skills needed for nurses’ career advancement. Materials and Methods A qualitative approach using content analysis was adopted to study a purposive sample of eighteen nurses working in teaching hospitals affiliated with the Qazvin, Shahid Beheshti, and Iran Universities of Medical Sciences. The data were collected through semi-structured interviews, and analyzed using conventional content analysis. Results The three themes extracted from the data included interpersonal capabilities, competency for career success, and personal capacities. The results showed that acquiring a variety of skills is essential for career advancement. Conclusions The findings showed that personal, interpersonal, and functional skills can facilitate nurses’ career advancement. The effects of these skills on career advancement depend on a variety of conditions that require further studies. PMID:27556054

  14. Assuring Quality and Access in Advanced Practice Nursing: A Challenge to Nurse Educators.

    ERIC Educational Resources Information Center

    Mundinger, Mary O.; Cook, Sarah Sheets; Lenz, Elizabeth R.; Piacentini, Karen; Auerhahn, Carolyn; Smith, Jennifer

    2000-01-01

    Advanced practice nurses are assuming increasingly accountable roles in primary health care. A doctor of nursing practice degree would signify the high level of competency they achieve. Columbia University's training model is an example of the preparation needed for this level of professional practice. (SK)

  15. Nursing Management of Advanced Merkel Cell Carcinoma.

    PubMed

    Lowry, Pamela A; Freeman, Morganna L; Russell, Jeffery S

    2016-11-01

    Merkel cell carcinoma (MCC) is a rare and lethal skin cancer with few known treatment options. Management of this disease is challenging, and oncology nurses must understand the medical, physical, and psychosocial burden that MCC places on the patient and family caregivers. Patients must navigate a complex medical and insurance network that often fails to support patients with rare cancers. Nurses must advocate for these patients to ensure quality comprehensive cancer care.

  16. Technological Advances in Nursing Care Delivery.

    PubMed

    Sullivan, Debra Henline

    2015-12-01

    Technology is rapidly changing the way nurses deliver patient care. The Health Information Technology for Economic and Clinical Health Act of 2009 encourages health care providers to implement electronic health records for meaningful use of patient information. This development has opened the door to many technologies that use this information to streamline patient care. This article explores current and new technologies that nurses will be working with either now or in the near future.

  17. Advanced nurse roles in UK primary care.

    PubMed

    Sibbald, Bonnie; Laurant, Miranda G; Reeves, David

    2006-07-03

    Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected patients. Reductions in cost are context dependent and rarely achieved. This is because savings on nurses' salaries are often offset by their lower productivity (due to longer consultations, higher patient recall rates, and increased use of tests and investigations). Gains in efficiency are not achieved when GPs continue to provide the services that have been delegated to nurses, instead of focusing on the services that only doctors can provide. Unintended consequences of extending nursing roles include loss of personal continuity of care for patients and increased difficulties with coordination of care as the multidisciplinary team size increases. Rapid access to care is, however, improved. There is a high capital cost involved in moving to multidisciplinary teams because of the need to train staff in new ways of working; revise legislation governing scope of practice; address concerns about legal liability; and manage professional resistance to change. Despite the unintended consequences and the high costs, extending nursing roles in primary care is a plausible strategy for improving service capacity without compromising quality of care or health outcomes for patients.

  18. Nursing staff's understanding expressions of people with advanced dementia disease.

    PubMed

    Eggers, Thomas; Ekman, Sirkka-Liisa; Norberg, Astrid

    2013-01-01

    People with advanced dementia disease (ADD) are known to have communication difficulties and thus it presents a challenge in understanding the expressions of these people. Because successful communication presupposes cooperation at least between 2 individuals, both individual's actions must be acknowledged. The aim of this study is to describe nursing staff's ways of understanding the expressions of people with ADD when communicating with them. Interviews from 8 nursing staff were analyzed using qualitative content analysis. Two themes were constructed: "Being in communication" and "Doing communication." Being in communication means that nursing staff perceive people with ADD as being capable of communication. Doing communication means that nursing staff attempt different individualized strategies to understand what people with ADD communicate. Good care of people with ADD presupposes nursing staff that are willing and able to relate to other people and to maintain good care for people with ADD continuous education and supervision are needed.

  19. The covered wagon journey: student chronicles in advanced holistic nursing.

    PubMed

    Purnell, Marguerite J; Lange, Bernadette; Bailey, Christie; Drozdowicz, Aleida; Eckes, Shirley; Kinchen, Elizabeth; Smith-Atkinson, Nikkisha

    2013-01-01

    This article recounts the experiences of a first cohort of graduate students in a newly implemented advanced holistic nursing (AHN) track, one of only a handful in the nation, and the first in Florida. The increasing popularity of complementary and alternative healing processes represents the insufficiency of a health system of fragmented care and a desire for holistic healing that is beyond mainstream allopathic care. Graduate holistic nurse education equips nurses to explore the commitment needed to advance the evolution of health care. The covered wagon journey is a metaphor for this meaningful participation. Students journaled their experiences as cotravelers in a lone wagon: embarking on a courageous journey, forging a path of discovery, and reaching their destination as pioneers. This cohort experience embodied the central tenets of holistic nursing, thus creating conscious change and unity within a learning community. The future of AHN is addressed in the context of the contemporary health care environment.

  20. Cognitive therapy: a training model for advanced practice nurses.

    PubMed

    Reilly, Christine E; McDanel, Heather

    2005-05-01

    1. Mental health needs exist in medically underserved areas and can be addressed in nurse-managed, community-based health centers. 2. Cognitive therapy techniques can be used in community-based health centers to intervene and alleviate patients' distress and improve their adherence to treatment. 3. A training program in cognitive therapy can help advanced practice nurses and other health care providers implement the techniques needed to address many behavioral and mental health problems.

  1. Advance directive communications practices:social worker's contributions to the interdisciplinary health care team.

    PubMed

    Black, Kathy

    2005-01-01

    This article presents a comparative study about social workers' interdisciplinary advance directive communication practices with patients at several hospitals located in upstate New York. The sample consisted of physicians (n=32), nurses (n=74), and social workers (n=29). The research surveyed advance directive communication practices by discipline utilizing a self-administered questionnaire. Advance directive communication was operationalized as a cumulative process incorporating the following phases that were measured as scales: initiation of the topic, disclosure of information, identification of a surrogate decision-maker, discussion of treatment options, elicitation of patient values, interaction with family members, and collaboration with other health care professionals. Results suggest that social workers offer distinct skills in their advance directive communication practices and discuss advance directives more frequently than either physicians or nurses.

  2. The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study

    PubMed Central

    Zambas, Shelaine I.; Smythe, Elizabeth A.; Koziol-Mclain, Jane

    2016-01-01

    Aims and objectives The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. Background Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of “advanced” physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. Design This qualitative study used a hermeneutic pragmatic approach. Method Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. Results The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. Conclusion Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. Relevance to clinical practice The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting. PMID:27607193

  3. Advance Directives and Do Not Resuscitate Orders

    MedlinePlus

    ... an advance directive. For example, someone who has terminal cancer might write that she does not want ... education, patient information, power of attorney, resuscitate, state, terminal care, wishes End-of-Life Issues, Healthcare Management, ...

  4. An overview of Medicare reimbursement regulations for advanced practice nurses.

    PubMed

    Frakes, Michael A; Evans, Tracylain

    2006-01-01

    The federal government spends nearly 15% of the budget on Medicare services annually, and advanced practice nurses are eligible for reimbursement from that pool. The regulations governing reimbursement are complex because of the social, political, and financial pressures involved in their development. Although economic viability and due diligence considerations make it incumbent on advanced practice nurses to understand the rules, the profession, as a whole, has knowledge deficits in this area. The essentials of regulatory development and structure are reviewed and considerations for optimizing reimbursement are described.

  5. Professional development for an advanced practice nursing team.

    PubMed

    Pye, Sherry; Green, Angela

    2011-05-01

    Since its development in 1998, the Cardiology Advanced Practice Nurse team has been plagued by retention issues. The coordinator for the team developed this leadership project while participating in the 2008 to 2009 Maternal-Child Health Leadership Academy sponsored by Sigma Theta Tau International and Johnson & Johnson. The focus of this project was to develop, implement, and evaluate initiatives to empower the advanced practice nurse team, promote their professional development, and ultimately improve retention of team members. Although evaluation data show progress toward addressing work environment issues, retention remains an ongoing problem.

  6. [Chronic diseases and complexity: new roles in nursing. Advanced practice nurses and chronic patient].

    PubMed

    Sánchez-Martín, C Inmaculada

    2014-01-01

    The increase in chronic diseases and the progressive ageing of the population is a source of concern for the different agencies with responsibility for health care. This has led to the creation of many documents focused on the analysis of the current situation and care of chronic diseases, including the WHO recommendations intended to assist countries and health services design and implement strategies that will address the existing demand, control and prevention of chronic diseases. In addition, there is a need to respond to the demand generated by chronic diseases in every sense, and from the different systems it is becoming more difficult to get enough support from multidisciplinary teams where the nurse has a central importance. While chronic diseases are becoming a threat due to the costs they generate, it is also an opportunity for nursing to be at the forefront for advanced care requirements, performed by professionals with recognized advanced clinical skills and ability for case management while monitoring and controlling complex chronic patients. The different services of the National Health System have introduced nurses that play different roles (cases managers, liaison nurses, advanced practice nurses and so on). However, it could be argued that they are not being trained to a desirable development level. It is therefore time for health care authorities to determine the role of the advanced practice nurse in relation to functional positions, and allow them to make an advance in the development of unified skills for the whole National Health System. From our experience we have learned that the advanced practice nurse is a resource that helps in the sustainability of services, thanks to the efficiency shown in the results obtained from the care given to both chronic and complex chronic patients.

  7. Kenya and distance education: a model to advance graduate nursing.

    PubMed

    Mutea, Naomi; Cullen, Deborah

    2012-08-01

    Africa is faced with a myriad of challenges, such as HIV/AIDS, malaria, tuberculosis, and a variety of political and historical complications that have affected the educational system for advanced nursing practice. In Kenya, the current situation in the higher education sector does not give nurses an opportunity to pursue graduate education after they have acquired the basic diploma in nursing due to limited government support and the type of education system existing in the country today. Although distance education has been available in Kenya for professionals such as teachers, in public universities, this kind of opportunity is unreachable for nurses who are working and need to further their education. Nurses desire to have access to advanced practice education to equip them with the relevant knowledge to cope and address the complex health issues arising in the management and care of patients. A collaborative model is presented as a potential solution for this need. Four major constituents are identified including hospitals and agencies, communities of interest, Kenyan universities and international education partners. Each has a part to play including contributions to information, communication of opinion and expertise, money and support, infrastructure and in-kind resources. Distance education is cost-effective and will help in building capacity at various levels of nursing including leadership in clinical practice, teaching, administration and research.

  8. Successful Advance Directives through Quality Disease Management.

    PubMed

    Parke, Bob; Krajewski, Adam

    2010-01-01

    Recently there has been talk about the benefit of advance care planning. This is an issue which resurfaces from time to time, as is evident in recent New England Journal of Medicine articles and editorials (April 2010). It has also resurfaced in Canada in a recent document titled Advance Care Planning in Canada: National Framework for Consultation (Health Canada 2010). This document acknowledges that many of us believe in the value of advance directives, finding "that most of the general public (60-90%) is supportive of advance care planning. However, only 10-20% of the public in the US, Canada and Australia have completed an advance care plan of any kind" (Health Canada 2010: 6). In Muriel R. Gillick's editorial in the New England Journal Medicine, she strongly makes the point that few people complete advance directives and further states that "directives have been a resounding failure" (Gillick 2010: 1239). These statements, although not exhaustive on the subject, show that we have a problem translating the support for advance directives into actual plans.

  9. The role of the nurse executive in fostering and empowering the advanced practice registered nurse.

    PubMed

    Talbert, Tukea L

    2012-06-01

    The nurse executive plays a critical role in the design, oversight, and outcomes of the delivery of care and a key role in the success of the integration of advanced practice registered nurses (APRNs) into an organization. The critical areas that nurse executives must consider to foster and empower APRNs are: (1) knowledge and self preparation, especially of political initiatives that affect the role, (2) visionary leadership and development of clear role expectations and appropriate credentialing, (3) strategies to reduce disconnection between the APRN and their practice setting, and (4) appropriate education and marketing of the role to stakeholders.

  10. Advancing nursing leadership: a model for program implementation and measurement.

    PubMed

    Omoike, Osei; Stratton, Karen M; Brooks, Beth A; Ohlson, Susan; Storfjell, Judy Lloyd

    2011-01-01

    Despite the abundant literature documenting the need for nurse management education and career development, only recently have professional standards been targeted for this group. Competency standards for nurse leaders repeatedly identify systems-level concepts including finance and budget, communication skills, strategic management, human resources management, change management, and computer technology skills. However, educational initiatives to meet these standards are still at the early stages and most nurse leaders continue to acquire knowledge and experience through "on-the-job" training. This article will illustrate the need for partnerships and collaboration between academia and hospitals to advance nursing leadership to the next century. In addition, a tool to measure the impact of a graduate certificate program in nursing administration on nurse leader competencies is presented. Overall, the certificate program has been successful in multiple ways; it has "graduated" almost 80 nurse leaders, improved participant competence in their role at the systems level, as well as providing an impetus for completion of a graduate degree post program.

  11. [Anticoagulant therapy clinic: moving towards Advanced Nursing Practice].

    PubMed

    Romero Ruiz, Adolfo; Parrado Borrego, Gema; Rodríguez González, José; Caparrós Miranda, Isabel S; Vargas Lirio, M Isabel; Ortiz Fernández, Primitiva

    2014-01-01

    There is currently around one million people receiving oral anticoagulants in Spain. The drug most used is acenocoumarol, which requires coagulation monitoring to ensure that the patient is within its normal therapeutic range. Patients usually start this treatment in a hospital clinic and, when they are stabilised, they are referred to primary care, where they are followed-up by their community nurses. The usual practice is that nurses are responsible for changes in the dose when the patients are outside the range. This practice is not performed by hospital nurses, despite having sufficient experience and knowledge to adequately manage these types of patients. An Advanced Nursing Practice model has been introduced into the Haematology management unit of the Hospital Universitario Virgen de la Victoria, Málaga. This involves various aspects of attention and care of patients on anticoagulant therapy, and includes adjusting the doses of their treatment following a catalogue of therapeutic and diagnostic ranges.

  12. Advanced education for the role of rural nurse generalist.

    PubMed

    Long, K A; Scharff, J E; Weinert, C

    1997-02-01

    The Montana State University College of Nursing has developed a master's degree program which prepares nurses as generalists with advanced knowledge for understanding and addressing rural health care needs. The programs is clear about its goals and objectives and does not attempt to be "all things for all people." The emphasis is on rural nursing, and this emphasis is present in recruiting, teaching, research and publication at the College. Classroom and clinical experiences challenge students to develop a broad range of skills, and most importantly to enhance critical thinking and problem-solving abilities. Since delivering high quality health care in rural areas requires the ability to understand health care from the consumer's perspective, both data collection and clinical experience in rural communities are required. The enthusiasm for rural nursing--practice, teaching and research--displayed by faculty members, alumnae and students is both a major factor in, and an indication of, the program's success.

  13. Advancing Information and Communication Technology Knowledge for Undergraduate Nursing Students

    PubMed Central

    Procter, Paula M

    2012-01-01

    Nursing is a dynamic profession; for registered nurses their role is increasingly requiring greater information process understanding and the effective management of information to ensure high quality safe patient care. This paper outlines the design and implementation of Systems of eCare. This is a course which advances information and communication technology knowledge for undergraduate nursing students within a Faculty of Health and Wellbeing appropriately preparing nurses for their professional careers. Systems of eCare entwines throughout the three year programme mapping to the curriculum giving meaning to learning for the student. In conclusion comments from students convey their appreciation of the provision of this element of the undergraduate programme. PMID:24199114

  14. Departmental portfolio in nursing - An advanced instrument.

    PubMed

    Rassin, M; Silner, D; Ehrenfeld, M

    2006-01-01

    In this paper, we will demonstrate the importance of the departmental portfolio; suggest an execution plan, and present initial impressions from a pilot project of developing the concept of a departmental portfolio. The portfolio is well known in the field of nursing and so far has been used by individuals mainly as a personal tool in furthering one's professional career. In this paper, we will suggest that expanding the use of a portfolio will be also beneficial at a collective level, by creating a departmental portfolio. The main objective of the departmental portfolio is to further the educational and professional development of the department members, by using it as an educating, evaluating, and administrative tool. We argue that a departmental portfolio should consist of several chapters: a professional presentation of the department, including its nursing world view; the work related to the development of the staff and education in service; information that coordinates actions designed to further the nursing treatment for patients, and information that depicts the achievements of the department in fields such as service, education, research, and publication.

  15. Advanced nurse practitioner-led abdominal therapeutic paracentesis.

    PubMed

    Aplin, Neal

    2017-03-10

    Liver disease is a common cause of death in England and Wales, and ascites is associated with a 50% mortality rate. Most patients who present with ascites have underlying liver cirrhosis, and often require therapeutic paracentesis for symptomatic relief. This article describes a competency framework that was developed to enable advanced nurse practitioners to perform therapeutic paracentesis in an ambulatory care unit.

  16. A Pilot of a Gerontological Advanced Practice Nurse Preventive Intervention

    ERIC Educational Resources Information Center

    Hahn, Joan Earle; Aronow, Harriet Udin

    2005-01-01

    Background: Persons with an intellectual and developmental disability frequently face barriers in accessing preventive services in community-based health care systems. As they age into middle years, they are at increased risk for functional decline. This paper presents a description of an advanced practice nurse (APN) intervention used in a pilot…

  17. Advancing Your Career: Concepts of Professional Nursing. Second Edition.

    ERIC Educational Resources Information Center

    Kearney, Rose

    This textbook, intended for registered nurses (RN's) returning to school, is designed to provide practicing RN's with professional concepts to advance their careers. The book contains 22 chapters organized in five sections. Each chapter includes chapter objectives, key terms, key points, chapter exercises, references, and a bibliography. Section I…

  18. The implementation of a new-graduate nurse residency training program directly into psychiatric-mental health nursing.

    PubMed

    Nadler-Moodie, Marlene; Loucks, Jeannine

    2011-12-01

    The specialty of psychiatric mental health nursing, as with all of nursing, has reached a critical shortage, which is posing a crisis in health care. Historically, the practice in schools of nursing has been to strongly encourage graduates to experience medical-surgical nursing during their first year of employment while discouraging those new graduates who may be interested in going directly into a specialty from doing so. New-graduate nurse residency training programs have focused on the general nursing areas such as critical care, emergency nursing, and medical-surgical nursing, leaving the specialty area of psychiatric mental health with less of a cadre to draw from, as attraction to these training programs is great among new-graduate nurses. The focus of this article is the description of a creative and successful new-graduate residency training program directly into psychiatric mental health nursing. The components of this program are easily replicable to other facilities and nursing specialties.

  19. [Advance directives for end-of-life care].

    PubMed

    Golan, Ofra G

    2009-04-01

    The provision of care for the dying patient confronts the caring team with very complex ethical dilemmas that doctors have no "medical" means to manage. Such decisions should be made according to the patient's will and preferences reflecting the value of life and the quality of life. However, many patients are not competent at this stage to decide or to express their wishes. Therefore, the Dying Patient Law of 2005, recognized advance expression of will through advance directives and power of attorney. Yet, there are many difficulties in the actual application of this idea. Dr. Shalev's article in this issue, to which this editorial relates, discusses the problems of communication between doctor and patient at the stage of preparing advance directives, and suggests a way to handle these deliberations. The Israeli law of 2005 provides some original solutions to other obstacles presented in the Literature as causing "the failure of the Living will". One resolution is the requirement that an explanation of the relevant medical information be given by a doctor or a nurse to the person who wishes to prepare written advance directives. This article suggests that the required explanation should be given within the framework of a discussion that simulates a process of informed consent for an unknown scenario at the end-of-life. Such discussions should be conducted as a dialogue, in which the doctor, first and foremost, Listens to the patient in order to clarify his/her worries and wishes, according to which specific medical orders can then be formulated.

  20. Educational Changes to Support Advanced Practice Nursing Education

    PubMed Central

    LeFlore, Judy L.; Thomas, Patricia E.

    2016-01-01

    Educational factors limit the number of advanced practice registered nurse (APRN) graduates to meet the growing workforce demands. Healthcare dynamics are necessitating a shift in how nursing education envisions, creates, and implements clinical learning opportunities. The current clinical education model in APRN programs continues to be the same as it was 45 years ago when the student numbers were much smaller. New approaches in graduate nursing education are needed to address the shortage of APRNs in primary and acute care areas. Determining competency based on the number of clinical hours can be inefficient, ineffective, and costly and limits the ability to increase capacity. Little research exists in graduate nursing education to support the effectiveness and efficiency of current hours of clinical required for nurse practitioner students. Simulation and academic-practice partnership models can offer innovative approaches to nurse practitioner education for clinical training, with the goal of producing graduates who can provide safe, quality care within the complex practice-based environment of the nation's evolving healthcare system. PMID:27465446

  1. Transnationalism: A Framework for Advancing Nursing Research with Contemporary Immigrants

    PubMed Central

    Rosemberg, Marie-Anne S.; Boutain, Doris M.; Mohammed, Selina A.

    2016-01-01

    This article advances nursing research by presenting transnationalism as a framework for inquiry with contemporary immigrants. Transnationalism occurs when immigrants maintain relationships that transcend the geographical borders of their origin and host countries. Immigrants use those relationships to experience health differently within concurrent socioeconomic, political and cultural contexts than national situated populations. Nurse researchers are called upon to consider these trans-border relationships when exploring the health of contemporary immigrants. Such consideration is needed to develop relevant research designs, methods, analysis, and dissemination strategies. PMID:26836998

  2. Nursing entrepreneurship: motivators, strategies and possibilities for professional advancement and health system change.

    PubMed

    Wall, Sarah

    2013-06-01

    In Canada, as well as internationally, efficiency-focused organizational restructuring in healthcare has resulted in stressful job change for nurses, although nurses continue to work in a system that values technology-based, physician-provided services. Employed nurses have had to participate in organizational activities that undermine their professional values and goals. Nursing entrepreneurship presents an opportunity to explore nursing's professional potential in nursing practice that is uniquely independent. In this study, a focused ethnographic approach was used to explore the experiences of self-employed nurses, who see themselves as leaders in advancing the profession of nursing and its contribution to healthcare. Key themes in the findings include the responses of self-employed nurses to health system change, expanded roles for nurses, the consequences of this non-traditional approach to nursing work and the possibilities for change that arise from nursing entrepreneurship. This research has implications for healthcare policy, professional advocacy and nursing education.

  3. Advanced practice nursing in Latin America and the Caribbean: regulation, education and practice

    PubMed Central

    Zug, Keri Elizabeth; Cassiani, Silvia Helena De Bortoli; Pulcini, Joyce; Garcia, Alessandra Bassalobre; Aguirre-Boza, Francisca; Park, Jeongyoung

    2016-01-01

    Abstract Objective: to identify the current state of advanced practice nursing regulation, education and practice in Latin America and the Caribbean and the perception of nursing leaders in the region toward an advanced practice nursing role in primary health care to support Universal Access to Health and Universal Health Coverage initiatives. Method: a descriptive cross-sectional design utilizing a web-based survey of 173 nursing leaders about their perceptions of the state of nursing practice and potential development of advanced practice nursing in their countries, including definition, work environment, regulation, education, nursing practice, nursing culture, and perceived receptiveness to an expanded role in primary health care. Result: the participants were largely familiar with the advanced practice nursing role, but most were unaware of or reported no current existing legislation for the advanced practice nursing role in their countries. Participants reported the need for increased faculty preparation and promotion of curricula reforms to emphasize primary health care programs to train advanced practice nurses. The vast majority of participants believed their countries' populations could benefit from an advanced practice nursing role in primary health care. Conclusion: strong legislative support and a solid educational framework are critical to the successful development of advanced practice nursing programs and practitioners to support Universal Access to Health and Universal Health Coverage initiatives. PMID:27508923

  4. Direct care registered nurses' and nursing leaders' review of the clinical competencies needed for the successful nurse of the future: a gap analysis.

    PubMed

    Strong, Margaret; Kane, Irene; Petras, Denise; Johnson-Joy, Cheryl; Weingarten, Joseph

    2014-01-01

    Direct care nurses and nurse leaders were surveyed on their perceptions of the appropriateness, importance, and use in daily practice of 10 clinical nursing competencies needed for nurses to be successful in the future. Competencies needed in the 21st century are not based entirely on task-driven motor skills because comprehensive knowledge is essential to care for complex patients. Differences identified between direct care nurses, leaders, and educational levels provide educational opportunities for both groups.

  5. Advancing diversity through inclusive excellence in nursing education.

    PubMed

    Bleich, Michael R; MacWilliams, Brent R; Schmidt, Bonnie J

    2015-01-01

    Nurse leaders call for a more diverse nursing workforce, but too few address the concept of inclusion as a recruitment and retention strategy or as part of improving the academic learning milieu. This article addresses organizational considerations of diversity and inclusion as part of the agenda established by the Association of American Colleges and Universities for inclusive excellence, building on the idea that academic environments only become excellent when an inclusive climate is reached. Six organizational strategies to inclusion are presented from the authors' experiences, some structural and others behavioral: admissions processes, invisibility, absence of community, promotion and tenure, exclusion, and tokenism. A call for structural and behavioral adaptions within nursing education to advance an inclusive excellence agenda is presented.

  6. A primer for nurses on advancing health reform policy.

    PubMed

    Ridenour, Nancy; Trautman, Deborah

    2009-01-01

    Health care reform is a high priority on the federal policy agenda. The authors present insights from their experiences as Robert Wood Johnson Foundation Health Policy Fellows working in Speaker Nancy Pelosi's office and on the House Committee on Ways and Means. Nursing has many opportunities at this juncture to engage in policy discussions and advance solutions for issues related to increasing quality and access while dampening the escalating cost of care. Strategies where nursing's voice can inform reform conversations include chronic disease management, prevention and health promotion, community-based care, nurse-managed care, interdisciplinary education, safety and quality, use of health information technology, and testing the comparative effectiveness of interventions and delivery systems.

  7. 42 CFR 431.20 - Advance directives.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Advance directives. 431.20 Section 431.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... effective date of the change in State law, to Medicaid providers and health maintenance organizations....

  8. 42 CFR 431.20 - Advance directives.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Advance directives. 431.20 Section 431.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... effective date of the change in State law, to Medicaid providers and health maintenance organizations....

  9. A Comparison of State Advance Directive Documents

    ERIC Educational Resources Information Center

    Gunter-Hunt, Gail; Mahoney, Jane E.; Sieger, Carol E.

    2002-01-01

    Purpose: Advance directive (AD) documents are based on state-specific statutes and vary in terms of content. These differences can create confusion and inconsistencies resulting in a possible failure to honor the health care wishes of people who execute health care documents for one state and receive health care in another state. The purpose of…

  10. Direct care nurses' knowledge in acute myocardial infarction treatment.

    PubMed

    Eckman, Thea; Haley, Rebecca; Bradley, Elisabeth; Albert, Maria; Kolm, Paul; Jurkovitz, Claudine

    2012-01-01

    An acronym, a button, a script card, and a lot of fun are all an educator needs to turn dreaded education into a great learning experience for nurses as well as the patients. A multidisciplinary team pilot tested a new learning approach on a cardiac step-down unit. The goal was to educate both nurses and patients about the American Heart Association's Get-With-the-Guidelines Program for Coronary Artery Disease. The educational strategies were successful, and data revealed an increase in nursing knowledge of core measures. After a two-phase study, the program was eventually rolled out hospital-wide. The study results show that nurses' compliance with and knowledge of the AHA core measures increased as a direct result of the program.

  11. The Relationship between Self-Directed Learning Readiness and Student Retention in Nursing Education

    ERIC Educational Resources Information Center

    Larmon, Brandy H.

    2015-01-01

    Retention in higher education, especially nursing education, is a concern for nurse educators. Due to the needs of nurse graduates and practicing nurses, the characteristic of self-directed learning in students is often an educational goal of a rigorous nursing curriculum. Program retention is often impacted by such demands. This study, based upon…

  12. Use of information technology by advanced practice nurses.

    PubMed

    Gaumer, Gary L; Koeniger-Donohue, Rebecca; Friel, Christina; Sudbay, Mary Beth

    2007-01-01

    The purpose of this study is to describe the use of information technology by advance practice nurses. A survey of 519 graduates of the Simmons College nurse practitioner program was conducted. Areas of investigation included the nurse practitioner's use of informatics technology, perception of information technology competence, adequacy of information technology training and support in the workplace, specific information technology health functions used in the workplace, and perceived benefits of using information technology. The data on the 249 usable responses were analyzed using descriptive statistics. These analyses compare the use of information technology by type of job, specialty, years of practice, and setting of work. Results indicate that more than 90% of nurse practitioners utilize computers at work, yet a large fraction of them still have low self-perception of information technology competence, believe initial training at the work site was inadequate, and believe that academic preparation for information technology was also inadequate. There is considerable variation in these measures across nurse practitioner specialties, settings of care, job characteristics, and experience.

  13. Advances in the directed evolution of proteins

    PubMed Central

    Lane, Michael D.; Seelig, Burckhard

    2014-01-01

    Natural evolution has produced a great diversity of proteins that can be harnessed for numerous applications in biotechnology and pharmaceutical science. Commonly, specific applications require proteins to be tailored by protein engineering. Directed evolution is a type of protein engineering that yields proteins with the desired properties under well-defined conditions and in a practical time frame. While directed evolution has been employed for decades, recent creative developments enable the generation of proteins with previously inaccessible properties. Novel selection strategies, faster techniques, the inclusion of unnatural amino acids or modifications, and the symbiosis of rational design approaches and directed evolution continue to advance protein engineering. PMID:25309990

  14. Consultant pharmacists, advanced practice nurses, and the interdisciplinary team.

    PubMed

    Resnick, Barbara

    2014-03-01

    Although in geriatrics we are better than many other clinical disciplines in terms of providing interdisciplinary care to older adults, I hope that we will continue to recognize how much more could actually be done. Before addressing the relationship between advanced practice nurses (APNs) and consultant pharmacists in real world settings, I want to review teamwork in geriatrics in general. It is critical to define what we mean by team, what type of team, and what the goals are of this teamwork.

  15. 78 FR 54255 - HRSA's Bureau of Health Professions Advanced Education Nursing Traineeship Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-03

    ...) nearing graduation, in an effort to expeditiously meet the growing demand for primary care nurse practitioners and nurse midwives. FOR FURTHER INFORMATION CONTACT: Joan Wasserman, DrPH, RN, Advanced...

  16. Health Care Professionals' Death Attitudes, Experiences, and Advance Directive Communication Behavior

    ERIC Educational Resources Information Center

    Black, Kathy

    2007-01-01

    The study surveyed 135 health care professionals (74 nurses, 32 physicians, and 29 social workers) to examine their personal death attitudes and experiences in relation to their reported advance directive communication practice behavior. Negative correlations were found between collaborating with other health care professionals regarding the…

  17. Discovering the nature of advanced nursing practice in high dependency care: a critical care nurse consultant's experience.

    PubMed

    Fairley, Debra

    2005-06-01

    This paper describes how a critical care nurse consultant's clinical role has evolved within a surgical high dependency unit (SHDU) in a large teaching hospitals trust. In order to provide some background to role development, an overview of the research exploring the nature of advanced nursing practice in the context of critical care will be presented. From the outset, advanced nursing practice was not perceived as the acquisition and application of technical procedures usually undertaken by doctors, but possibly an integration of medicine and nursing where holistic nursing assessment is combined with symptom-focused physical examination. A reflective account of practical problems encountered relating to role integration, professional autonomy, legal and consent issues, non-medical prescribing, and role evaluation will be presented. A model of working that can be applied to high dependency units, integrating the role of the advanced nurse practitioner within the clinical team, will be described.

  18. The positive attitudes and perceptions of care managers about advance directives.

    PubMed

    Golden, Adam G; Tewary, Sweta; Qadri, Syeda; Zaw, Khin; Ruiz, Jorge G; Roos, Bernard A

    2011-03-01

    In a previous intervention, we found that reminders from care managers failed to increase the number of their homebound older adult clients with advance directives. Thus, in the current study, we looked at the perceptions and attitudes of care managers about the need to discuss advance directives with their clients. Ninety-five care managers serving community-based nursing home-eligible older adults completed an 18-question survey, which found that care managers overwhelmingly believe it is important to address advance directives. Only 3.2% reported that discussing advance directives is time consuming. No attitudinal barriers were identified. Given their positive attitudes about advance directives, care managers need educational interventions that will provide the knowledge and skills to interact effectively with clients who are resistant to addressing end-of-life issues.

  19. Design and contents of an advanced distance-based statistics course for a PhD in nursing program.

    PubMed

    Azuero, Andres; Wilbanks, Bryan; Pryor, Erica

    2013-01-01

    Doctoral nursing students and researchers are expected to understand, critique, and conduct research that uses advanced quantitative methodology. The authors describe the design and contents of a distance-based course in multivariate statistics for PhD students in nursing and health administration, compare the design to recommendations found in the literature for distance-based statistics education, and compare the course contents to a tabulation of the methodologies used in a sample of recently published quantitative dissertations in nursing. The authors conclude with a discussion based on these comparisons as well as with experiences in course implementation and directions for future course development.

  20. Advanced Practice Nursing Competency Assessment Instrument (APNCAI): clinimetric validation

    PubMed Central

    Sastre-Fullana, Pedro; Morales-Asencio, Jose Miguel; Sesé-Abad, Albert; Fernández-Domínguez, Juan Carlos; De Pedro-Gómez, Joan

    2017-01-01

    Objective To describe the development and clinimetric validation of the Advanced Practice Nursing Competency Assessment Instrument (APNCAI) through several evidence sources about reliability and validity in the Spanish context. Design and setting APNCAI development was based on a multisequential and systematic process: literature review, instrument content consensus through qualitative Delphi method approach (a panel of 51 Advanced Practice in Nursing –APN– experts was selected) and the clinimetric validation process based on a sample of 600 nurses from the Balearic Islands public healthcare setting. Methods An initial step for tool's content development process based on Delphi method approach of expert consensus was implemented. A subsequent phase of tool validation started from the analysis of APN core competencies latent measurement model, including exploratory and confirmatory techniques. Reliability evidence for each latent factor was also obtained. Items' scores were submitted to descriptive analysis, plus univariate and multivariate normality tests. Results An eight-factor competency assessment latent model obtained adequate fit, and it was composed by ‘Research and Evidence-Based Practice’, ‘Clinical and Professional Leadership’, ‘Interprofessional Relationship and Mentoring’, ‘Professional Autonomy’, ‘Quality Management’, ‘Care Management’, ‘Professional Teaching and Education’ and ‘Health Promotion’. Conclusions Adequate empirical evidence of reliability and validity for APNCAI makes it useful for application in healthcare policy programmes for APN competency assessment in Spain. PMID:28235968

  1. Blueprint for development of the advanced practice psychiatric nurse workforce.

    PubMed

    Hanrahan, Nancy P; Delaney, Kathleen R; Stuart, Gail W

    2012-01-01

    The mental health system is inefficient and ineffective in providing behavioral health care services to the 1 in 4 Americans who have a mental illness or a substance abuse problem. Current health care reform initiatives present a significant opportunity for advanced practice psychiatric nurses-psychiatric mental health (APRN-PMH) to develop action-oriented recommendations for developing their workforce and thereby increasing access to high-quality and full-spectrum behavioral health care services. If endorsed by the professional nursing associations and the APRN-PMH workforce, the strategies presented in this paper provide a blueprint for developing the APRN-PMH workforce. Achieving these goals will significantly reform the APRN-PMH workforce, thereby contributing to the overall goal of supporting an integrated model of behavioral health care. No change has as much potential to influence the APRN-PMH workforce as the uniting of all APRN-PMHs in a "Blueprint for APRN-PMH Workforce Development."

  2. Immunotherapy for advanced melanoma: future directions.

    PubMed

    Valpione, Sara; Campana, Luca G

    2016-02-01

    As calculated by the meta-analysis of Korn et al., the prognosis of metastatic melanoma in the pretarget and immunological therapy era was poor, with a median survival of 6.2 and a 1-year life expectancy of 25.5%. Nowadays, significant advances in melanoma treatment have been gained, and immunotherapy is one of the promising approaches to get to durable responses and survival improvement. The aim of the present review is to highlight the recent innovations in melanoma immunotherapy and to propose a critical perspective of the future directions of this enthralling oncology subspecialty.

  3. Addressing cultural incongruities of advance directives.

    PubMed

    Pacquiao, D

    2001-01-01

    Shared meanings and socially constructed realities have great significance to individuals and families facing critical illness, pain, suffering, or death. Actions are often based on the context of the professional and dominant societal culture. The concept of Advance Directives is consistent with the dominant value orientation in the American culture of self-reliance and individualism, which places a high premium on self-determination and control of one's own destiny. However, this value is not always consistent with the dominant cultural views of particular sick or dying individuals. Thus, at a time when individuals and their families need the most support, institutionalized care often creates incongruities and meaninglessness.

  4. Advance Directives - Multiple Languages: MedlinePlus

    MedlinePlus

    ... sharing features on this page, please enable JavaScript. Arabic (العربية) Chinese - Simplified (简体中文) Chinese - Traditional (繁體中文) Japanese (日本語) Russian (Русский) Somali (af Soomaali) Spanish (español) Arabic (العربية) Advance Directives (Arabic) التوجيهات المسبقة - العربية Bilingual ...

  5. Advanced practice nursing in performing arts health care.

    PubMed

    Weslin, Anna T; Silva-Smith, Amy

    2010-06-01

    Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.

  6. Addressing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Advanced Practice Nursing Education.

    ERIC Educational Resources Information Center

    Nokes, Kathleen M.; Stein, Gary L.

    1997-01-01

    A survey of 23 advanced practice nursing programs showed only 3 had HIV-specific graduate-level nursing courses. Recommendations were made for HIV-specific courses, integration of HIV content into other courses, use of Centers for Disease Control and Occupational Safety and Health Administration guidelines, and subspecialties in HIV nursing. (SK)

  7. Geysers advanced direct contact condenser research

    SciTech Connect

    Henderson, J.; Bahning, T.; Bharathan, D.

    1997-12-31

    The first geothermal application of the Advanced Direct Contact Condenser (ADCC) technology developed by the National Renewable Energy Laboratory (NREL) is now operational and is being tested at The Geysers Power Plant Unit 11. This major research effort is being supported through the combined efforts of NREL, The Department of Energy (DOE), and Pacific Gas and Electric (PG&E). NREL and PG&E have entered into a Cooperative Research And Development Agreement (CRADA) for a project to improve the direct-contact condenser performance at The Geysers Power Plant. This project is the first geothermal adaptation of an advanced condenser design developed for the Ocean Thermal Energy Conversion (OTEC) systems. PG&E expects this technology to improve power plant performance and to help extend the life of the steam field by using steam more efficiently. In accordance with the CRADA, no money is transferred between the contracting parties. In this case the Department of Energy is funding NREL for their efforts in this project and PG&E is contributing funds in kind. Successful application of this technology at The Geysers will provide a basis for NREL to continue to develop this technology for other geothermal and fossil power plant systems.

  8. Advanced Practice Registered Nurses. Final rule with comment period.

    PubMed

    2016-12-14

    The Department of Veterans Affairs (VA) is amending its medical regulations to permit full practice authority of three roles of VA advanced practice registered nurses (APRN) when they are acting within the scope of their VA employment. Certified Registered Nurse Anesthetists (CRNA) will not be included in VA's full practice authority under this final rule, but comment is requested on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking. The final rulemaking establishes the professional qualifications an individual must possess to be appointed as an APRN within VA, establishes the criteria under which VA may grant full practice authority to an APRN, and defines the scope of full practice authority for each of the three roles of APRN. The services provided by an APRN under full practice authority in VA are consistent with the nursing profession's standards of practice for such roles. This rulemaking increases veterans' access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians, and it permits VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA.

  9. Career advancement and educational opportunities: experiences and perceptions of internationally educated nurses.

    PubMed

    Salma, Jordana; Hegadoren, Kathleen M; Ogilvie, Linda

    2012-01-01

    The number of internationally educated nurses is increasing in the Canadian workforce. Recruitment of internationally educated nurses is often seen as a solution to ongoing nursing shortages. However, international recruitment needs to be accompanied by strategies to ensure long-term retention. One of the criteria for successful retention is the availability and accessibility of career advancement and educational opportunities. Little research exists on the opportunities for career advancement and education for internationally educated nurses in Canada. This interpretive descriptive study was conducted to look at the perceptions of internationally educated nurses regarding career advancement and educational opportunities in Alberta, Canada. Eleven internationally educated nurses, working as registered nurses in Alberta, were interviewed using semi-structured interviews. Five themes were identified: motherhood as a priority, communication and cultural challenges, process of skill recognition, perceptions of opportunity and need for mentorship.

  10. Advancing a program of research within a nursing faculty role.

    PubMed

    Nolan, Marie T; Wenzel, Jennifer; Han, Hae-Ra; Allen, Jerilyn K; Paez, Kathryn A; Mock, Victoria

    2008-01-01

    Doctoral students and new faculty members often seek advice from more senior faculty on how to advance their program of research. Students may ask whether they should choose the manuscript option for their dissertation or whether they should seek a postdoctoral fellowship. New faculty members wonder whether they should pursue a career development award and whether they need a mentor as they strive to advance their research while carrying out teaching, service, and practice responsibilities. In this article, we describe literature on the impact of selected aspects of pre- and postdoctoral training and faculty strategies on scholarly productivity in the faculty role. We also combine our experiences at a school of nursing within a research-intensive university to suggest strategies for success. Noting the scarcity of research that evaluates the effect of these strategies, we are actively engaged in collecting data on their relationship to the scholarly productivity of students and faculty members within our own institution.

  11. The Texas Advanced Directive Law: Unfinished Business.

    PubMed

    Kapottos, Michael; Youngner, Stuart

    2015-01-01

    The Texas Advance Directive Act allows physicians and hospitals to overrule patient or family requests for futile care. Purposefully not defining futility, the law leaves its determination in specific cases to an institutional process. While the law has received several criticisms, it does seem to work constructively in the cases that come to the review process. We introduce a new criticism: While the law has been justified by an appeal to professional values such as avoiding harm to patients, avoiding the provision of unseemly care, and good stewardship of medical resources, it is applied incompletely. It allows physicians and institutional committees to refuse "futile" treatments desired by patients and families while at the same time providing no way of regulating physicians who recommend or even push "futile" treatments in similar cases. In this sense, the TADA is incomplete on its own terms.

  12. Beyond competence: advance directives in dementia research.

    PubMed

    Jongsma, Karin Rolanda; van de Vathorst, Suzanne

    2015-01-01

    Dementia is highly prevalent and incurable. The participation of dementia patients in clinical research is indispensable if we want to find an effective treatment for dementia. However, one of the primary challenges in dementia research is the patients' gradual loss of the capacity to consent. Patients with dementia are characterized by the fact that, at an earlier stage of their life, they were able to give their consent to participation in research. Therefore, the phase when patients are still competent to decide offers a valuable opportunity to authorize research, by using an advance research directive (ARD). Yet, the use of ARDs as an authorization for research participation remains controversial. In this paper we discuss the role of autonomous decision-making and the protection of incompetent research subjects. We will show why ARDs are a morally defensible basis for the inclusion of this population in biomedical research and that the use of ARDs is compatible with the protection of incompetent research subjects.

  13. Professional excellence and career advancement in nursing: a conceptual framework for clinical leadership development.

    PubMed

    Adeniran, Rita Kudirat; Bhattacharya, Anand; Adeniran, Anthony A

    2012-01-01

    Increasingly, stakeholders in the health care community are recognizing nursing as key to solving the nation's health care issues. This acknowledgment provides a unique opportunity for nursing to demonstrate leadership by developing clinical nurse leaders to collaborate with the multidisciplinary care team in driving evidence-based, safe quality, cost-effective health care services. One approach for nursing success is standardizing the entry-level education for nurses and developing a uniform professional development and career advancement trajectory with appropriate incentives to encourage participation. A framework to guide and provide scientific evidence of how frontline nurses can be engaged will be paramount. The model for professional excellence and career advancement provides a framework that offers a clear path for researchers to examine variables influencing nurses' professional development and career advancement in a systematic manner. Professional Excellence and Career Advancement in Nursing underscores professional preparedness of a registered nurse as central to leadership development. It also describes the elements that influence nurses' participation in professional development and career advancement under 4 main categories emphasizing mentorship and self-efficacy as essential variables.

  14. Effectiveness of Advanced Illness Care Teams for Nursing Home Residents with Dementia

    ERIC Educational Resources Information Center

    Chapman, Dennis G.; Toseland, Ronald W.

    2007-01-01

    This study evaluated the effectiveness of advanced illness care teams (AICTs) for nursing home residents with advanced dementia. The AICTs used a holistic approach that focused on four domains: (1) medical, (2) meaningful activities, (3) psychological, and (4) behavioral. The authors recruited 118 residents in two nursing homes for this study and…

  15. Chinese baccalaureate nursing students' readiness for self-directed learning.

    PubMed

    Yuan, Hao Bin; Williams, Beverly A; Fang, Jin Bo; Pang, Dong

    2012-05-01

    This descriptive cross-sectional study was conducted with 536 Chinese nursing students to explore students' readiness for self-directed learning (SDL). The Self-Directed Learning Readiness (SDLR) Scale for nursing education (Chinese translation version) was used. The value of the content validity index tested by five experts was 0.915. A measure of internal consistency (Cronbach's alpha) was 0.925 on the total scale. Students possessed readiness for SDL with a mean score of 157.72 (S.D.=15.08, 62.3% in high level, and 37.7% in low level). The attributes of Chinese students, such as a strong sense of responsibility and perseverance, due diligence and rigorous self-discipline, enable students to take the initiative and responsibility for their own learning. The existing variation in students' readiness for SDL is helpful in identifying student characteristics that might be used to modify learning activities for these students. Senior students had higher scores for SDLR than junior students. This finding likely reflects the maturational process of developing self-directedness. Promoting SDL skills is a challenging process for faculty members and students. It is helpful if nurse educators assess the learning styles and preferences of their students in order to determine the level of SDL activities to include from year to year in the curriculum.

  16. Comparison of patients' and health care professionals' attitudes towards advance directives.

    PubMed Central

    Blondeau, D; Valois, P; Keyserlingk, E W; Hébert, M; Lavoie, M

    1998-01-01

    OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. SETTING: Health care institutions in the province of Québec, Canada. Survey sample: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy. PMID:9800589

  17. Differences in Presenting Advance Directives in the Chart, in the Minimum Data Set, and through the Staffs Perceptions

    ERIC Educational Resources Information Center

    Cohen-Mansfield, Jiska; Libin, Alexander; Lipson, Steven

    2003-01-01

    Purpose: Decisions concerning end-of-life care depend on information contained in advance directives that are documented in residents' charts in the nursing home. The availability of that information depends on the quality of the chart and on the location of the information in the chart. No research was found that compared directives by the manner…

  18. The Advanced Automated Directional Solidification Furnace

    NASA Technical Reports Server (NTRS)

    Gillies, D. C.; Reeves, F. A.; Jeter, L. B.; Sledd, J. D.; Cole, J. M.; Lehoczky, S. L.

    1996-01-01

    The Advanced Automated Directional Solidification Furnace (AADSF) is a five zone tubular furnace designed for Bridgman-Stockbarger, other techniques of crystal growth involving multiple temperature zones such as vapor transport experiments and other materials science experiments. The five zones are primarily designed to produce uniform hot and cold temperature regions separated by an adiabatic region constructed of a heat extraction plate and an insert to reduce radiation from the hot to the cold zone. The hot and cold zone temperatures are designed to reach 1600 C and 1100 C, respectively. AADSF operates on a Multi-Purpose Experiment Support Structure (MPESS) within the cargo bay of the Space Shuttle on the United States Microgravity Payload (USMP) missions. Two successful flights, both employing the directional solidification or Bridgman Stockbarger technique for crystal growth have been made, and crystals of HgCdTe and PbSnTe grown in microgravity have been produced on USMP-2 and USMP-3, respectively. The addition of a Sample Exchange Mechanism (SEM) will enable three different samples to be processed on future flights including the USMP-4 mission.

  19. Emerging areas of science: Recommendations for Nursing Science Education from the Council for the Advancement of Nursing Science Idea Festival.

    PubMed

    Henly, Susan J; McCarthy, Donna O; Wyman, Jean F; Heitkemper, Margaret M; Redeker, Nancy S; Titler, Marita G; McCarthy, Ann Marie; Stone, Patricia W; Moore, Shirley M; Alt-White, Anna C; Conley, Yvette P; Dunbar-Jacob, Jacqueline

    2015-01-01

    The Council for the Advancement of Nursing Science aims to "facilitate and recognize life-long nursing science career development" as an important part of its mission. In light of fast-paced advances in science and technology that are inspiring new questions and methods of investigation in the health sciences, the Council for the Advancement of Nursing Science convened the Idea Festival for Nursing Science Education and appointed the Idea Festival Advisory Committee (IFAC) to stimulate dialogue about linking PhD education with a renewed vision for preparation of the next generation of nursing scientists. Building on the 2005 National Research Council report Advancing The Nation's Health Needs and the 2010 American Association of Colleges of Nursing Position Statement on the Research-Focused Doctorate Pathways to Excellence, the IFAC specifically addressed the capacity of PhD programs to prepare nursing scientists to conduct cutting-edge research in the following key emerging and priority areas of health sciences research: omics and the microbiome; health behavior, behavior change, and biobehavioral science; patient-reported outcomes; big data, e-science, and informatics; quantitative sciences; translation science; and health economics. The purpose of this article is to (a) describe IFAC activities, (b) summarize 2014 discussions hosted as part of the Idea Festival, and (c) present IFAC recommendations for incorporating these emerging areas of science and technology into research-focused doctoral programs committed to preparing graduates for lifelong, competitive careers in nursing science. The recommendations address clearer articulation of program focus areas; inclusion of foundational knowledge in emerging areas of science in core courses on nursing science and research methods; faculty composition; prerequisite student knowledge and skills; and in-depth, interdisciplinary training in supporting area of science content and methods.

  20. Mindfulness-Based Stress Reduction in Advanced Nursing Practice

    PubMed Central

    Williams, Hants; Simmons, Leigh Ann; Tanabe, Paula

    2015-01-01

    The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary. PMID:25673578

  1. Technology, cognitive remediation, and nursing: directions for successful cognitive aging.

    PubMed

    Vance, David E; McNees, Patrick; Meneses, Karen

    2009-02-01

    Many older adults experience cognitive difficulties and declines as a part of normal aging. Nurses and other health care professionals will require assistance in technologies that can help older patients maintain or improve cognition. Cognitive remediation represents a well-established laboratory approach that augments cognitive functioning in older adults. Emerging technologies allow such cognitive remediation to be self-administered through gaming software, making it convenient, fun, and inexpensive to deliver. As such, guiding older patients, as well as some facilities, in this direction may be a way to help. However, certain caveats and suggestions are warranted.

  2. Direct anticoagulants and nursing: an approach from patient's safety.

    PubMed

    Romero Ruiz, Adolfo; Romero-Arana, Adolfo; Gómez-Salgado, Juan

    In recent years, a new line of treatment for the prevention of stroke in non-valvular atrial fibrillation, the so-called direct anticoagulants or new anticoagulants has appeared. The proper management and follow-up of these patients is essential to minimize their side effects and ensure patient safety. In this article, a description of these drugs is given, analyzing their characteristics, functioning and interactions together with the most habitual nursing interventions, as well as a reflection on the implications for the practice.

  3. Quality nursing care for hospitalized patients with advanced illness: concept development.

    PubMed

    Izumi, Shigeko; Baggs, Judith G; Knafl, Kathleen A

    2010-08-01

    The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability.

  4. A clinical advancement program for registered nurses with an outpatient focus.

    PubMed

    Streeter, Bonnie L

    2007-01-01

    Clinical advancement programs have been in use for almost 30 years. Although clinical advancement programs have been designed for many areas, it appears that one has never been developed specific to the outpatient-focused registered nurse. This article describes the development of a clinical advancement program for non-hospital-based registered nurses employed at the Guthrie Clinic in Sayre, Pennsylvania and highlights recommendations for instituting this program in any outpatient setting.

  5. The Vanderbilt Professional Nursing Practice Program, part 3: managing an advancement process.

    PubMed

    Steaban, Robin; Fudge, Mitzie; Leutgens, Wendy; Wells, Nancy

    2003-11-01

    Consistency of performance standards across multiple clinical settings is an essential component of a credible advancement system. Our advancement process incorporates a central committee, composed of nurses from all clinical settings within the institution, to ensure consistency of performance in inpatient, outpatient, and procedural settings. An analysis of nurses advanced during the first 18 months of the program indicates that performance standards are applicable to nurses in all clinical settings. The first article (September 2003) in this 3-part series described the foundation for and the philosophical background of the Vanderbilt Professional Nursing Practice Program (VPNPP), the career advancement program underway at Vanderbilt University Medical Center. Part 2 described the development of the evaluation tools used in the VPNPP, the implementation and management of this new system, program evaluation, and improvements since the program's inception. The purpose of this article is to review the advancement process, review the roles of those involved in the process, and to describe outcomes and lessons learned.

  6. Cost-effectiveness of a WOC Advanced Practice Nurse in the Acute Care and Outpatient Setting

    PubMed Central

    2014-01-01

    Increasing numbers of advanced practice nurses who practice within the WOC specialty are challenged by the need to justify their role by demonstrating clinical and fiscal benefits to the employing agency. This View From Here column describes the steps I took while completing such an analysis for a position for a nurse practitioner with WOC certification in upstate New York. PMID:24918767

  7. Appreciating history: the Australian experience of direct-entry mental health nursing education in universities.

    PubMed

    Happell, Brenda

    2009-02-01

    More than two decades since the introduction of comprehensive nursing education in Australia, the controversy regarding the type of undergraduate education that would best serve the needs of the mental health nursing profession continues. The ensuing debate tends to be based on a comparison between the current model of comprehensive education in the universities and the specialist mental health nursing programs that previously operated within the hospital system. The previous existence of a tertiary-based direct-entry mental health nursing program in Victoria is generally not recognized. The paper provides a brief overview of mental health nursing education from a historical perspective emphasizing the period following the commencement of the transfer of the nursing education. Articulating the Victorian experience of specialist undergraduate mental health nursing education within universities is essential as discussions about the most appropriate educational preparation for mental health nursing continues.

  8. The Vanderbilt Professional Nursing Practice Program, part 2: Integrating a professional advancement and performance evaluation system.

    PubMed

    O'Hara, Nancy F; Duvanich, Mary; Foss, Julie; Wells, Nancy

    2003-10-01

    Developing a performance-based advancement system requires evaluation tools that capture essential behaviors and outcomes reflective of key nursing functions. To ensure relevance to clinical practice and enhance buy-in from nursing staff, the behaviors and outcomes were defined by a broad cross-section of nursing staff and administrators. The first article (September 2003) in this 3-part series described the foundation for and the philosophical background of the Vanderbilt Professional Nursing Practice Program (VPNPP), the career advancement program under way at Vanderbilt University Medical Center. This second article describes the development of the evaluation tools used in the VPNPP, the implementation and management of this new system, program evaluation, and improvements since the inception of the program. Additionally, the authors present the challenges and lessons we learned in development and implementation of a dynamic evaluation system that supports our career advancement program. The process of advancing within the program will be described in part 3.

  9. Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations.

    PubMed

    Lane, Riki; Halcomb, Elizabeth; McKenna, Lisa; Zwar, Nicholas; Naccarella, Lucio; Davies, Gawaine Powell; Russell, Grant

    2016-04-21

    Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce.Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territoriesResults Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies.Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices.What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses' skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally

  10. Institutional Influences on Nurse-Academics' Instructional Planning Decisions in the Implementation of Basic Nursing Curricula in Colleges of Advanced Education in New South Wales.

    ERIC Educational Resources Information Center

    Roberts, Kathryn L.

    A study examined institutional influences on the instructional planning decisions of nurse-academics presenting basic nursing curricula in colleges of advanced education (CAEs) in New South Wales. Data were collected from the following sources: survey of 86 selected nurse-academics from 12 of New South Wales' 15 tertiary institutions running basic…

  11. Assessment of advanced practice palliative care nursing competencies in nurse practitioner students: implications for the integration of ELNEC curricular modules.

    PubMed

    Shea, Joyce; Grossman, Sheila; Wallace, Meredith; Lange, Jean

    2010-04-01

    Advanced practice nurses (APRNs) have key roles in the care of patients who are nearing death and those living with a disabling chronic disease. This article describes a mixed-method formative assessment of 36 graduate nursing students' knowledge about and attitudes toward palliative care preliminary to curricular integration of the End-of-Life Nursing Education Consortium (ELNEC) graduate core modules. Students' knowledge about palliative care was assessed using the 106-item ELNEC examination. In addition, qualitative data were gathered regarding students' definitions of palliative care, the role of the APRN in palliative care, and their definitions of a "good" and "bad" death. Results revealed students' limited knowledge about palliative care. Qualitative findings indicated that most students exclusively linked palliative care with end-of-life care and believed that the treatment they provide should have the goal of prolonging life over maintaining quality of life. Implications for curriculum design, advanced practice role development, and collaboration with community health partners are discussed.

  12. Nothing out of the ordinary: advanced fertility nursing practice.

    PubMed

    Allan, Helen; Barber, Debbie

    2004-12-01

    This paper discusses data from a case study of fertility nursing practice. An ethnographic case study approach using participant observation and nine semi-structured interviews with staff and patients was undertaken. The data were analysed thematically and these themes are discussed in this paper. We present the meaning a small group of nurses working in a fertility unit in the UK attach to new roles and the ways in which changes in practice may be influenced. The nurses in this study believed that nature of the task demanded changes to practice and they identified personal, interpersonal and socio-cultural factors which influenced these changes. These new roles facilitated greater continuity of care for patients. This paper discusses the effects of these new roles on knowing and intimacy in nurse - patient relationships. The data suggests that new nursing roles, which are based on "traditional" nursing and "new" technical skills, are fragile and may not be shared across a professional community.

  13. A spirit-focused conceptual model of nursing for the advanced practice nurse.

    PubMed

    Swanson, C S

    1995-01-01

    A spirit-focused conceptual model of nursing views the person as a spiritual being whose life and purpose arise from a personal relationship with God. The individual's definition of God determines how he or she responds to stimuli, sets goals, and establishes purpose in life. Consequently, this definition influences the professional nursing relationship, and the nurse's and patient's concepts of health and perceptions of the environment. The pediatric nurse practitioner and client are the primary examples of practice examined in this study.

  14. Advancing Nursing Informatics in the Next Decade: Recommendations from an International Survey.

    PubMed

    Topaz, Maxim; Ronquillo, Charlene; Peltonen, Laura-Maria; Pruinelli, Lisiane; Sarmiento, Raymond Francis; Badger, Martha K; Ali, Samira; Lewis, Adrienne; Georgsson, Mattias; Jeon, Eunjoo; Tayaben, Jude L; Kuo, Chiu-Hsiang; Islam, Tasneem; Sommer, Janine; Jung, Hyunggu; Eler, Gabrielle Jacklin; Alhuwail, Dari

    2016-01-01

    In the summer of 2015, the International Medical Informatics Association Nursing Informatics Special Interest Group (IMIA NISIG) Student Working Group developed and distributed an international survey of current and future trends in nursing informatics. The survey was developed based on current literature on nursing informatics trends and translated into six languages. Respondents were from 31 different countries in Asia, Africa, North and Central America, South America, Europe, and Australia. This paper presents the results of responses to the survey question: "What should be done (at a country or organizational level) to advance nursing informatics in the next 5-10 years?" (n responders = 272). Using thematic qualitative analysis, responses were grouped into five key themes: 1) Education and training; 2) Research; 3) Practice; 4) Visibility; and 5) Collaboration and integration. We also provide actionable recommendations for advancing nursing informatics in the next decade.

  15. Enhancing Success in Advanced Practice Nursing: a grant-funded project.

    PubMed

    McNeal, Gloria J; Walker, Donita

    2006-01-01

    The Enhancing Success in Advanced Practice Nursing (ESAPN) Project is designed to improve access to a diverse and culturally competent and sensitive health professions workforce by increasing the number of Hispanic, African-American and Asian nurses recruited, enrolled in and graduated from the MSN program at the University of Medicine and Dentistry of New Jersey-School of Nursing (UMDNJ-SN). In addition, the project plan includes the development and implementation of a comprehensive program that incorporates academic support services, career advisement and mentoring activities to retain and graduate an increased number of culturally, racially and ethnically diverse advanced practice nurses for the State of New Jersey. The project also seeks to improve the quality of care by preparing advanced practice nurses to provide culturally competent and sensitive care by assuring that the MSN curriculum includes content and clinical experiences relevant to the development of cultural competence. Faculty participation in workshops, designed to increase knowledge of cultural competence, is a key component. The success of the project will be evaluated using a variety of measures that track increases in the number of diverse students recruited and enrolled, the number of students accessing services associated with the ESAPN program, and increased retention and graduation of Hispanic, African-American and Asian nurses prepared as advanced practice nurses.

  16. Applying the Advancing Excellence in America's Nursing Homes Circle of Success to improving and sustaining quality.

    PubMed

    Bakerjian, Debra; Zisberg, Anna

    2013-01-01

    Looking forward to the Quality Assurance Performance Improvement (QAPI) program to be implemented and required in 2014, and as nursing home staff provide care for residents with increasingly complex health issues, knowledge of how to implement quality improvement (QI) is imperative. The nursing home administrator and director of nursing (DON) provide overall leadership, but it is the primary responsibility of the DON and other registered nurse staff to implement and manage the day to day QI process. This article describes potential roles of nursing leaders and key components of a QI project using a pressure ulcer case study exemplar to illustrate a quality improvement process. The authors suggest specific methods that RN leaders can employ using the Advancing Excellence Campaign Circle of Success as an organizing framework along with evidence-based resources. Nursing home leaders could use this article as a guideline for implementing any clinical quality improvement process.

  17. Competency Recommendations for Advancing Nursing Informatics in the Next Decade: International Survey Results.

    PubMed

    Ronquillo, Charlene; Topaz, Maxim; Pruinelli, Lisiane; Peltonen, Laura-Maria; Nibber, Raji

    2017-01-01

    The IMIA-NIstudents' and emerging professionals' working group conducted a large international survey in 2015 regarding research trends in nursing informatics. The survey was translated into half-a-dozen languages and distributed through 18 international research collaborators' professional connections. The survey focused on the perspectives of nurse informaticians. A total of 272 participants responded to an open ended question concerning recommendations to advance nursing informatics. Five key areas for action were identified through our thematic content analysis: education, research, practice, visibility and collaboration. This chapter discusses these results with implications for nursing competency development. We propose how components of various competency lists might support the key areas for action. We also identify room to further develop existing competency guidelines to support in-service education for practicing nurses, promote nursing informatics visibility, or improve and facilitate collaboration and integration with other professions.

  18. Successfully incorporating Writing Across the Curriculum with advanced writing in nursing.

    PubMed

    Luthy, Karlen E; Peterson, Neil E; Lassetter, Jane H; Callister, Lynn C

    2009-01-01

    The purpose of this article is to explain the concepts of Writing Across the Curriculum, Writing in the Disciplines, and Writing to Learn, and to describe the incorporation of advanced writing into a baccalaureate nursing program and provide suggestions for accessing resources and promoting success. The goals of incorporating Writing Across the Curriculum, Writing in the Disciplines, and Writing to Learn concepts into nursing curriculum are to assist nursing students to achieve competence in clinically relevant writing assignments; to demonstrate critical thinking and communication skills, both oral and written; to execute useful literature searches; to read and understand research reports; and to encourage the incorporation of evidence into clinical practice. With a strong and established writing foundation, nursing students will be more successful in written and oral communication during their nursing program and throughout their nursing career.

  19. [Screening for melanoma, an advanced practice nurse consultation].

    PubMed

    Farrayre, Annie; Roland, Nathalie; Akotiale, Sophie; Avril, Marie-Françoise

    2014-12-01

    In the dermatology consultation, at Cochin hospital, Paris, a nurse cooperates with a dermatologist in order to insure the clinical follow-up for high-risk melanoma patients. To adopt this innovative public health approach, the nurse has received theoretical, clinical and educational knowledge.

  20. Reaching for the stars: career advancement and the registered nurse.

    PubMed

    Walker, Kim

    2005-08-01

    Clinical nursing has long struggled to secure the place of primacy it deserves in the profession's hierarchy of importance and worth. It is ironic that, even at the beginning of the 21st century, a clinical nurse is generally not as well-recognized, rewarded or remunerated as a colleague working in nursing management, education or research. Until the profession recognizes and takes serious action to remedy this situation, the crisis of recruitment and retention in nursing currently ravaging the globe is likely to continue. In this paper, I present a discursive account of an exciting initiative by a leading private, acute-care hospital which addresses this very problem. A new ladder for clinical nurse specialists (CNSs) introduces a rigorous and systematic approach to the appointment of three classifications of CNS, each requiring evidence of successively higher levels of competency, and which are accompanied by fiscal reward and stronger peer recognition.

  1. Integrating Advance Research Directives into the European Legal Framework.

    PubMed

    Andorno, Roberto; Gennet, Eloïse; Jongsma, Karin; Elger, Bernice

    2016-04-01

    The possibility of using advance directives to prospectively consent to research participation in the event of dementia remains largely unexplored in Europe. Moreover, the legal status of advance directives for research is unclear in the European regulations governing biomedical research. The article explores the place that advance research directives have in the current European legal framework, and considers the possibility of integrating them more explicitly into the existing regulations. Special focus is placed on issues regarding informed consent, the role of proxies, and the level of acceptable risks and burdens.

  2. A survey of role diversity among advanced practice nurses in pediatric gastroenterology.

    PubMed

    McDuffie, Adelina F; Huffman, Shari

    2005-01-01

    A survey of advanced practice nurses in the Association of Pediatric Gastroenterology and Nutrition Nurses (APGNN) was conducted to assess role diversity in anticipation of sharing these results with our international colleagues at the World Congress in 2004. A single-page, 14-item survey was sent via e-mail or fax to 79 APGNN advanced practice nurses identified by their credentials (MS, PNP, FNP) in the membership database. Forty surveys were returned via e-mail or fax for an overall response rate of 51%. Most reported working full time as nurse practitioners in an outpatient gastrointestinal clinic, yet almost one third were hospital based. Additional job titles included clinical nurse specialist, researcher, and case manager or clinical coordinator. Slightly more than one half reported seeing any patients in their outpatient practice, whereas 43% saw specific populations, with constipation, gastroesophageal reflux, and abdominal pain being the most common diagnoses. Seventy percent had prescriptive privileges. Billing practices were the most diverse, with 30% always billing under their own number, 23% sometimes billing under their own number, and 40% never billing under their own number (5% not applicable). Overall, most advanced practice nurses in APGNN are pediatric nurse practitioners with a primary focus on outpatient care but also are involved in patient and family teaching, nutrition support, home care, and research. Only a few were involved with procedures, which may be surprising to our adult counterparts.

  3. The TriCouncil for Nursing: An Interorganizational Collaboration for Advancing the Profession.

    PubMed

    Bednash, Geraldine Polly

    2015-01-01

    The TriCouncil for Nursing is a coalition of 4 leading nursing organizations: the American Association of Colleges of Nursing, the American Nurses Association, the American Organization of Nurse Executives, and the National League for Nursing. This informal, yet highly complex, collaboration has endeavored to advance the profession for almost 4 decades despite the inherent challenges in coalition formation and sustainment. Coalition building occurs when organizations seek the potential to advance common issues or protect individual resources or status, and by their very nature have the potential to fail. The history of the TriCouncil for Nursing provides evidence of the challenges associated with the process of developing consensus and the benefits of working to create consensus to achieve common goals. The commitment of the TriCouncil member organizations to sustain this coalition and find consensus across an array of challenging issues and in complex environments has created significant policy advances for the profession, which provides evidence of the benefits associated with this type of collaborative work. This coalition has continued despite the inherent challenges for organizations seeking consensus. The TriCouncil commitment to lead in advocacy for the profession and create significant policy to change health care models the value of this type of effort.

  4. Advanced Nursing Experience Is Beneficial for Lowering the Peritonitis Rate in Patients on Peritoneal Dialysis

    PubMed Central

    Yang, Zhikai; Xu, Rong; Zhuo, Min; Dong, Jie

    2012-01-01

    ♦ Objectives: We explored the relationship between the experience level of nurses and the peritonitis risk in peritoneal dialysis (PD) patients. ♦ Methods: Our observational cohort study followed 305 incident PD patients until a first episode of peritonitis, death, or censoring. Patients were divided into 3 groups according to the work experience in general medicine of their nurses—that is, least experience (<10 years), moderate experience (10 to <15 years), and advanced experience (≥15 years). Demographic characteristics, baseline biochemistry, and residual renal function were also recorded. Multivariate Cox regression was used to analyze the association of risks for all-cause and gram-positive peritonitis with patient training provided by nurses at different experience levels. ♦ Results: Of the 305 patients, 91 were trained at the initiation of PD by nurses with advanced experience, 100 by nurses with moderate experience, and 114 by nurses with the least experience. Demographic and clinical variables did not vary significantly between the groups. During 13 582 patient–months of follow-up, 129 first episodes of peritonitis were observed, with 48 episodes being attributed to gram-positive organisms. Kaplan–Meier analysis showed that training by nurses with advanced experience predicted the longest period free of first-episode gram-positive peritonitis. After adjustment for some recognized confounders, the advanced experience group was still associated with the lowest risk for first-episode gram-positive peritonitis. The level of nursing experience was not significantly correlated with all-cause peritonitis risk. ♦ Conclusions: The experience in general medicine of nurses might help to lower the risk of gram-positive peritonitis among PD patients. These data are the first to indicate that nursing experience in areas other than PD practice can be vital in the training of PD patients. PMID:21719682

  5. [Psychiatric advance directives--medical models into psychiatric medicine].

    PubMed

    Mautner, Sigal; Lachman, Max; Kaplan, Zeev; Shalev, Anat

    2014-01-01

    Since the year 2005, in the field of general medicine, the legislature in Israel determined ways to implement medically advanced directives according to the power of the law. Different states in the world had implemented parallel legislation for patients who suffer from mental illness. Psychiatric Advance Directives is a legitimate document which is valid in Australia, New Zealand, Scotland, England and in 25 countries in the U.S.A. Psychiatric advance directives (PAD's) allow competent persons, through advance instructions, to state their preferences for future mental health treatment in the event of an incapacitating psychiatric crisis. Self Determination Theory, Self Care and Autonomy are dominant supportive approaches in the creation of Psychiatric Advance Directives. Research conducted on psychiatric advance directives shows positive potential benefits for mental health clients, therapists and psychiatrists. More research in that area must be conducted. Psychiatric advance directives are currently developed and implemented with the cooperation of the Tauber Foundation and the Beer Sheva Mental Health Center. This is the first step in learning of effective ways to use this intervention in Israel and change perceptions toward a positive connection between medical efficiency and client preferences.

  6. Education and Advance Care Planning in Nursing Homes: The Impact of Ownership Type.

    ERIC Educational Resources Information Center

    Walker, Leslie C.; Bradley, Elizabeth H.

    1998-01-01

    A study of 25 nonprofit and 87 for-profit nursing homes showed both types likely to offer education on advance care planning. However, nonprofits were more likely to have ongoing discussions that covered more than life support decisions and to have ethics committees to support advance care planning. (SK)

  7. Advances in direct oxidation methanol fuel cells

    NASA Technical Reports Server (NTRS)

    Surampudi, S.; Narayanan, S. R.; Vamos, E.; Frank, H.; Halpert, G.; Laconti, Anthony B.; Kosek, J.; Prakash, G. K. Surya; Olah, G. A.

    1993-01-01

    Fuel cells that can operate directly on fuels such as methanol are attractive for low to medium power applications in view of their low weight and volume relative to other power sources. A liquid feed direct methanol fuel cell has been developed based on a proton exchange membrane electrolyte and Pt/Ru and Pt catalyzed fuel and air/O2 electrodes, respectively. The cell has been shown to deliver significant power outputs at temperatures of 60 to 90 C. The cell voltage is near 0.5 V at 300 mA/cm(exp 2) current density and an operating temperature of 90 C. A deterrent to performance appears to be methanol crossover through the membrane to the oxygen electrode. Further improvements in performance appear possible by minimizing the methanol crossover rate.

  8. Changing Directions: The Future of Associate Degree Nursing.

    ERIC Educational Resources Information Center

    Dillon, Patricia

    1997-01-01

    The majority of current nursing graduates are associate degree nurses (ADNs). However, recent trends, such as the shift to a worldwide health care market and community/primary care, suggest that a bachelor's degree is better preparation. Ways to increase the mobility of ADNs into bachelor's degree programs are needed. (SK)

  9. Caring for Patients with Advanced Breast Cancer: The Experiences of Zambian Nurses

    PubMed Central

    Maree, Johanna Elizabeth; Mulonda, Jennipher Kombe

    2017-01-01

    Objective: The objective of this study was to describe the experiences of Zambian nurses caring for women with advanced breast cancer. Methods: We used a qualitative descriptive design and purposive sampling. Seventeen in-depth interviews were conducted with registered nurses practicing in the Cancer Diseases Hospital and the University Teaching Hospital, Lusaka, Zambia, and analyzed using thematic analyses. Results: Two themes emerged from the data - caring for women with advanced breast cancer is challenging and the good outweighs the bad. The majority of the participants agreed that caring for women with advanced breast cancer and witnessing their suffering were challenging. Not having formal education and training in oncology nursing was disempowering, and one of the various frustrations participants experienced. The work environment, learning opportunities, positive patient outcomes, and the opportunity to establish good nurse–patient experiences were positive experiences. Conclusions: Although negative experiences seemed to be overwhelming, participants reported some meaningful experiences while caring for women with advanced breast cancer. The lack of formal oncology nursing education and training was a major factor contributing to their negative experiences and perceived as the key to rendering the quality of care patients deserved. Ways to fulfill the educational needs of nurses should be explored and instituted, and nurses should be remunerated according to their levels of practice. PMID:28217726

  10. Nurse anesthesia education in the new millennium: outcomes of a federally funded advanced nursing education grant.

    PubMed

    Beitz, Janice M; Kost, Michael

    2006-01-01

    Graduate nursing education is evolving in response to multiple societal influences affecting higher education. Nurse anesthesia education has also been affected by these forces. This article describes the planning, implementation, and evaluation of a new graduate track in nurse anesthesia made possible by an academic partnership, and the positive impact that a federally funded grant had on the venture. The excellent academic outcomes, the changes in diversity of the student body, the innovative curriculum, and lessons learned from the project are described.

  11. Advancing host-directed therapy for tuberculosis:

    PubMed Central

    Yang, Chul-Su

    2017-01-01

    Tuberculosis (TB) drug-development strategies, a wide range of candidate host-directed therapies (HDT)s-including new and repurposed drugs, biologics, and cellular therapies-have been proposed to accelerate eradication of infection and overcome the problems associated with current treatment regimens. By investigating the interaction between macrophages and the intracellular parasite Toxoplasma gondii (T. gondii), we uncovered that infection-induced signaling pathways suggest possibilities for the development of novel therapeutic modalities for TB that target the intracellular signaling pathways permitting the replication of Mycobacterium tuberculosis (MTB). PMID:28357397

  12. Professional Nurse Coaching: Advances in National and Global Healthcare transformation

    PubMed Central

    Hess, Darlene

    2013-01-01

    Nurse coaches are responding to the mandate of Florence Nightingale (1820-1910)—the foundational philosopher of modern nursing—to advocate, identify, and focus on factors that promote health, healthy people, and healthy communities that are recognized today as environmental and social determinants of health.1,2 The Institute of Medicine report3 and other health initiatives suggest the need for increased education and leadership from nurses to address the healthcare needs of our nation and world. Nurse coaches are strategically pos-i tioned and equipped to implement health-promoting and evidence-based strategies with clients and support behavioral and lifestyle changes to enhance growth, overall health, and well-being. With possibilities not yet imagined, employment opportunities for nurses who incorporate coaching into professional practice are developing across the entire spectrum of health, well-ness, and healing. PMID:24416681

  13. Controlling death: the false promise of advance directives.

    PubMed

    Perkins, Henry S

    2007-07-03

    Advance directives promise patients a say in their future care but actually have had little effect. Many experts blame problems with completion and implementation, but the advance directive concept itself may be fundamentally flawed. Advance directives simply presuppose more control over future care than is realistic. Medical crises cannot be predicted in detail, making most prior instructions difficult to adapt, irrelevant, or even misleading. Furthermore, many proxies either do not know patients' wishes or do not pursue those wishes effectively. Thus, unexpected problems arise often to defeat advance directives, as the case in this paper illustrates. Because advance directives offer only limited benefit, advance care planning should emphasize not the completion of directives but the emotional preparation of patients and families for future crises. The existentialist Albert Camus might suggest that physicians should warn patients and families that momentous, unforeseeable decisions lie ahead. Then, when the crisis hits, physicians should provide guidance; should help make decisions despite the inevitable uncertainties; should share responsibility for those decisions; and, above all, should courageously see patients and families through the fearsome experience of dying.

  14. Psychometric Properties of a Korean Measure of Person-Directed Care in Nursing Homes

    ERIC Educational Resources Information Center

    Choi, Jae-Sung; Lee, Minhong

    2014-01-01

    Objective: This study examined the validity and reliability of a person-directed care (PDC) measure for nursing homes in Korea. Method: Managerial personnel from 223 nursing homes in 2010 and 239 in 2012 were surveyed. Results: Item analysis and exploratory factor analysis for the first sample generated a 33-item PDC measure with eight factors.…

  15. The changing hope trajectory in patients with advanced-stage cancer: a nursing perspective.

    PubMed

    Sanders, Judith Brown; Seda, Julie S; Kardinal, Carl G

    2012-06-01

    As patients with advanced-stage cancer move from the initial diagnosis through treatment, remission, recurrence, and advanced-stage disease, the hope trajectory undergoes a dynamic transformation. By identifying the hope trajectory, nurses can help patients focus on obtainable hope objects while balancing the need to present a realistic prognosis. This, in turn, may help patients find meaning and purpose in advanced-stage cancer and facilitate realistic hope when faced with a life-threatening illness.

  16. The stigmatized patient with AIDS in the intensive care unit: the role of the advanced practice nurse.

    PubMed

    Mosier, L

    1994-11-01

    As the incidence of HIV infection rises, so will cases of HIV positive intensive care unit admissions. Factors affecting nurses' care of these patients include fear of contagion, homophobia, and lack of knowledge. A multidimensional approach must be taken by the advanced practice nurse to decrease stigmatization by changing knowledge and attitudes of intensive care unit nurses.

  17. Culture care theory: a major contribution to advance transcultural nursing knowledge and practices.

    PubMed

    Leininger, Madeleine

    2002-07-01

    This article is focused on the major features of the Culture Care Diversity and Universality theory as a central contributing theory to advance transcultural nursing knowledge and to use the findings in teaching, research, practice, and consultation. It remains one of the oldest, most holistic, and most comprehensive theories to generate knowledge of diverse and similar cultures worldwide. The theory has been a powerful means to discover largely unknown knowledge in nursing and the health fields. It provides a new mode to assure culturally competent, safe, and congruent transcultural nursing care. The purpose, goal, assumptive premises, ethnonursing research method, criteria, and some findings are highlighted.

  18. The psychiatric advanced practice nurse with prescriptive authority: role development, practice issues, and outcomes measurement.

    PubMed

    Cornwell, C; Chiverton, P

    1997-04-01

    Within the rapidly changing health care system, there is an increased need for professionals who can provide cost-effective primary health care for mentally ill patients. This article discusses the role of the Psychiatric Advanced Practice Nurse (APN) with Prescriptive Authority as a cost-effective, high-quality component of comprehensive mental health care delivery. Historical aspects of the development of the Nurse Practitioner (NP) role are discussed, as well as issues specific to the role in psychiatric nursing. The implementation of this role at Rochester is described, followed by recommendations for studying the impact of the psychiatric NP on care delivery, including process and outcome variables.

  19. Being a palliative nurse for persons with severe congestive heart failure in advanced homecare.

    PubMed

    Brännström, Margareta; Brulin, Christine; Norberg, Astrid; Boman, Kurt; Strandberg, Gunilla

    2005-12-01

    Advanced homecare for persons with congestive heart failure is a 'new' challenge for palliative nurses. The aim of this study is to illuminate the meaning of being a palliative nurse for persons with severe congestive heart failure in advanced homecare. Narrative interviews with 11 nurses were conducted, tape-recorded, and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. One meaning of being a palliative nurse is being firmly rooted and guided by the values of palliative culture. Being adaptable to the patient's way of life carries great weight. On one hand nurses live out this value, facilitating for the patients to live their everyday life as good as possible. Being a facilitator is revealed as difficult, challenging, but overall positive. On the other hand nurses get into a tight corner when values of palliative culture clash and do not correspond with the nurses interpretation of what is good for the person with congestive heart failure. Being in such a tight corner is revealed as frustrating and giving rise to feelings of inadequacy. Thus, it seems important to reflect critical on the values of palliative culture.

  20. Advanced progress concepts for direct coal liquefaction

    SciTech Connect

    Anderson, R.; Derbyshire, F.; Givens, E.

    1995-09-01

    Given the low cost of petroleum crude, direct coal liquefaction is still not an economically viable process. The DOE objectives are to further reduce the cost of coal liquefaction to a more competitive level. In this project the primary focus is on the use of low-rank coal feedstocks. A particular strength is the use of process-derived liquids rather than model compound solvents. The original concepts are illustrated in Figure 1, where they are shown on a schematic of the Wilsonville pilot plant operation. Wilsonville operating data have been used to define a base case scenario using run {number_sign}263J, and Wilsonville process materials have been used in experimental work. The CAER has investigated: low severity CO pretreatment of coal for oxygen rejection, increasing coal reactivity and mg inhibiting the propensity for regressive reactions; the application of more active. Low-cost Fe and Mo dispersed catalysts; and the possible use of fluid coking for solids rejection and to generate an overhead product for recycle. CONSOL has investigated: oil agglomeration for coal ash rejection, for the possible rejection of ash in the recycled resid, and for catalyst addition and recovery; and distillate dewaxing to remove naphthenes and paraffins, and to generate an improved quality feed for recycle distillate hydrogenation. At Sandia, research has been concerned with the production of active hydrogen donor distillate solvent fractions produced by the hydrogenation of dewaxed distillates and by fluid coking via low severity reaction with H{sub 2}/CO/H{sub 2}O mixtures using hydrous metal oxide and other catalysts.

  1. Competency for creation, use, and revocation of psychiatric advance directives.

    PubMed

    Srebnik, Debra S; Kim, Scott Y

    2006-01-01

    Psychiatric advance directives help promote patient involvement in treatment and expedite psychiatric care. However, clinicians are unsure of how to use directives, partly due to poor clarity regarding standards for capacity to create, use, and revoke them. This article recommends possible capacity standards. Capacity to create directives is a legal presumption, supported by empirical data. Standards are discussed for the subset of cases in which capacity assessment is needed. Use of directives may be triggered by incapacity to provide informed consent to treatment, although tailored, individualized points of activation may also be considered. In many states, revocation of a psychiatric advance directive requires adequate decision-making capacity. Setting a capacity standard for revocation presents challenges, however, in light of obstacles to providing treatment when revocation is attempted and the fact that many patients prefer revocable directives. As more directives are created and used, additional research and statutory refinements are warranted.

  2. Hospice referral after inpatient psychiatric treatment of individuals with advanced dementia from a nursing home.

    PubMed

    Epstein-Lubow, Gary; Fulton, Ana Tuya; Marino, Louis J; Teno, Joan

    2015-06-01

    This report addresses the discharge disposition following inpatient psychiatric treatment for advanced dementia. The total population included 685 305 Medicare fee-for-service decedents with advanced cognitive and functional impairment, with a mean age of 85.9 years who had resided in a nursing home. In the last 90 days of life, 1027 (0.15%) persons received inpatient psychiatry treatment just prior to the place of care where the individual died. Discharge dispositions included 132 (12.9%) persons to a medical hospital, 728 (70.9%) to nursing home without hospice services, 73 (7.1%) to hospice services in a nursing home, 32 (3.1%) to home without hospice services, and 16 (1.6%) to hospice services at home. Overall, the rate of referral to hospice services for advanced dementia was relatively low.

  3. Unity of knowledge in the advancement of nursing knowledge.

    PubMed

    Giuliano, Karen K; Tyer-Viola, Lynda; Lopez, Ruth Palan

    2005-07-01

    During the past 20 years, we have witnessed an explosion in nursing knowledge providing the discipline with diverse and multifaceted theoretical frameworks and paradigms. One knowledge theme that pervades the dialogue in the scholarly literature is that of multiple ways of knowing. With the acknowledgement that the fundamental nature of nursing knowledge is grounded in the understanding of human nature and its response to its environment, comes an imperative for a consilience of knowledge. The purpose of this article is to present such a unified worldview by articulating a vision of nursing knowledge, a meaning of unity of knowledge, and a challenge to the discipline to embrace inclusive rather than exclusive ways of knowing.

  4. Readiness for self-directed learning among nursing students in Thailand.

    PubMed

    Klunklin, Areewan; Viseskul, Nongkran; Sripusanapan, Acharaporn; Turale, Sue

    2010-06-01

    This study took place in Thailand where didactic and lecture-driven teaching styles are beginning to transform into student-centered methods. At Chiang Mai University Faculty of Nursing in Thailand, the readiness of 272 undergraduate students to undertake self-directed learning was investigated using two instruments: a demographic data questionnaire and Guglielmino's Self Directed Learning Readiness Scale. The study found that the overall self-directed learning readiness of participants was at a high level in the categories of openness to learning opportunities, self-concept as an effective learner, initiative and independence in learning, informed acceptance of responsibility for one's own learning, creativity, and the ability to use basic study and problem-solving skills. The findings provide encouragement to nurse educators to further apply self-directed learning in nursing courses, to improve teaching and learning methods, and promote life-long learning for nurses within Thailand and elsewhere.

  5. Premature rupture of the fetal membranes. An update for advanced practice nurses.

    PubMed

    Weitz, B W

    2001-01-01

    Advanced practice nurses in obstetric settings are frequently required to diagnose premature rupture of fetal membranes; co-management of care with physicians is becoming more common in many health care facilities. Therefore, Advanced practice nurses must have an in-depth understanding of this potentially severe obstetric complication. This article presents a review of the current literature focusing on the epidemiology, physiology, pathophysiology, prevention measures, subjective and objective assessment, diagnostic tests, and management of premature rupture of membranes. Psychosocial aspects of this event, often upsetting for the family, are also discussed.

  6. The mindful nurse leader: Advancing executive nurse leadership skills through participation in action learning.

    PubMed

    FitzPatrick, Kate; Doucette, Jeffrey N; Cotton, Amy; Arnow, Debra; Pipe, Teri

    2016-10-01

    In this second installment of a three-part series on mindfulness, we describe the process of producing video vignettes to illustrate how clinical nurses draw on the power of mindfulness to build their own resiliency while delivering compassionate care.

  7. Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advance care planning intervention

    PubMed Central

    Sinclair, Craig; Auret, Kirsten Anne; Evans, Sharon Frances; Williamson, Fiona; Dormer, Siobhan; Greeve, Kim; Koay, Audrey; Price, Dot; Brims, Fraser

    2017-01-01

    Objective Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed whether a systematic nurse-led ACP intervention increases ACP in patients with advanced respiratory disease. Design A multicentre open-label randomised controlled trial with preference arm. Setting Metropolitan teaching hospital and a rural healthcare network. Participants 149 participants with respiratory malignancy, chronic obstructive pulmonary disease or interstitial lung disease. Intervention Nurse facilitators offered facilitated ACP discussions, prompted further discussions with doctors and loved ones, and assisted participants to appoint a substitute medical decision-maker (SDM) and complete an advance directive (AD). Outcome measures The primary measure was formal (AD or SDM) or informal (discussion with doctor) ACP uptake assessed by self-report (6 months) and medical notes audit. Secondary measures were the factors predicting baseline readiness to undertake ACP, and factors predicting postintervention ACP uptake in the intervention arm. Results At 6 months, formal ACP uptake was significantly higher (p<0.001) in the intervention arm (54/106, 51%), compared with usual care (6/43, 14%). ACP discussions with doctors were also significantly higher (p<0.005) in the intervention arm (76/106, 72%) compared with usual care (20/43, 47%). Those with a strong preference for the intervention were more likely to complete formal ACP documents than those randomly allocated. Increased symptom burden and preference for the intervention predicted later ACP uptake. Social support was positively associated with ACP discussion with loved ones, but negatively associated with discussion with doctors. Conclusions Nurse-led facilitated ACP is acceptable to patients with advanced respiratory disease and effective in increasing ACP discussions and completion

  8. [Experiences of Austrian nursing staff in dealing with advance directives].

    PubMed

    Heindl, Patrik; Ruppert, Sabine; Kozon, Vlastimil

    2014-10-01

    Hintergrund: Die Patientenverfügung ist aufgrund der Betonung der Autonomie der PatientInnen und des zunehmenden medizinischen Fortschritts ein aktuelles Thema. Dabei zeigen sich Probleme sowohl in der Verfassung als auch bei der Umsetzung von Patientenverfügungen in den Institutionen. Die Aufgaben und der Einfluss der Pflege in diesem Zusammenhang sind noch kaum Gegenstand der wissenschaftlichen Untersuchungen. Dies ist der erste Artikel, der sich mit dieser Thematik auseinandersetzt. Ziel: Ziel der Untersuchung ist die Darstellung der Erfahrungen von österreichischen Pflegepersonen im Umgang mit Patientenverfügungen im Universitätskrankenhaus. Methode: Es wurde ein deskriptiv-exploratives Querschnittdesign angewendet. Die Datenerfassung erfolgte mittels Fragebögen im Jahr 2009. Insgesamt wurden 266 Pflegepersonen in einem österreichischen Universitätskrankenhaus befragt. Ergebnisse: Bei den Pflegepersonen zeigte sich eine große Unsicherheit bei gleichzeitigem Vorhandensein von ausreichendem theoretischen Fachwissen und fehlenden Strukturen von Seiten der Organisation. Dadurch entstanden einige interdisziplinäre Konflikte im Zusammenhang mit der Umsetzung der Patientenverfügung. Schlussfolgerungen: Um Konflikte zu vermeiden und den Umgang sowie die Umsetzung von Patientenverfügungen in der Praxis zu verbessern, ist die Etablierung einer klinischen Ethikberatung empfehlenswert. Aufgaben einer solchen Ethikberatung sind die Erstellung von Richtlinien in der Institution, die Durchführung von individuellen Fallbesprechungen und die Fort- und Weiterbildung der betroffenen Gesundheitsberufe.

  9. Advance directives in psychiatric care: a narrative approach

    PubMed Central

    Widdershoven, G.; Berghmans, R.

    2001-01-01

    Advance directives for psychiatric care are the subject of debate in a number of Western societies. By using psychiatric advance directives (or so-called "Ulysses contracts"), it would be possible for mentally ill persons who are competent and with their disease in remission, and who want timely intervention in case of future mental crisis, to give prior authorisation to treatment at a later time when they are incompetent, have become non-compliant, and are refusing care. Thus the devastating consequences of recurrent psychosis could be minimised. Ulysses contracts raise a number of ethical questions. In this article the central issues of concern and debate are discussed from a narrative perspective. Ulysses contracts are viewed as elements of an ongoing narrative in which patient and doctor try to make sense of and get a hold on the recurrent crises inherent in the patient's psychiatric condition. Key Words: Medical ethics • narrative ethics • advance directives • psychiatry PMID:11314165

  10. Gerontology found me: gaining understanding of advanced practice nurses in geriatrics.

    PubMed

    Campbell-Detrixhe, Dia D; Grassley, Jane S; Zeigler, Vicki L

    2013-10-01

    Examining the meanings of the experiences of advanced practice nurses (APNs) who chose to work with older adults and why they continue to work with this population was the focus of this hermeneutic qualitative research study. Twelve geriatric APNs currently practicing in two South Central states were interviewed using an open-ended interview guide. Using Gadamerian hermeneutics, the researchers identified Gerontology Found Me as the significant expression that reflected the fundamental meaning of the experience as a whole. Four themes emerged that further described the meanings of the participants' personal, educational, and professional experiences: Becoming a Gerontology Nurse, Being a Gerontology Nurse, Belonging to Gerontology, and Bringing Others to Gerontology. This study concluded that APNs' personal and professional experiences were more influential than educational experiences to become geriatric nurses, and having these personal and professional experiences of being in relationship with older individuals further contributed to their choice of gerontology.

  11. Palliative care for advanced dementia: a pilot project in 2 nursing homes.

    PubMed

    Kuhn, Daniel R; Forrest, Jeannine M

    2012-02-01

    This article describes a pilot project involving training, case consultations, and administrative coaching over a period of 1 year aimed at introducing palliative care in 2 nursing homes among 31 residents with advanced dementia. Resident outcomes that examined numerous clinical measures were assessed at 3 points in time. Changes in the knowledge and attitudes of 80 staff members and 33 family members who participated in the multimodal intervention were also assessed at 3 points in time. Limited improvements were demonstrated on measures for residents, staff members, and family members at the first nursing home (site 1) and significant improvements were demonstrated at the other nursing home (site 2). Top leadership turned over 3 times at site 1 which limited the integration of palliative care, whereas leadership of site 2 remained stable. Implications for implementing a program of palliative care in nursing homes are discussed.

  12. [Advance Directives: theoretical concept and practical significance in the USA].

    PubMed

    Vollmann, J; Pfaff, M

    2003-07-04

    The article examines on the basic of empirical data the discrepancy between the theoretical demand and the practical role of advance directives. Often advance directives have no influence on medical decision-making in clinical care of critically ill patients. The vague language of the widely used standard living wills and the lack of physician-patient communication in the process of delivering an advance directives are contributing factors. However, many physicians even disregard patients' preferences in concrete and meaningful living wills at the end of life. Besides the lack of information many even seriously ill patients do not deliver an advance because they misjudge their medical prognosis and life expectancy. Often the communication between patients and doctors are blocked because they expect from the each other the first step to talk about end of life decisions and advance directives. In this context physicians claim lack of time, training in communication skills and their discomfort in talking about death and dying with their patients.

  13. Dynamics of self-directed learning in M.Sc. nursing students: A qualitative research

    PubMed Central

    SHIRAZI, FATEMEH; SHARIF, FARKHONDEH; MOLAZEM, ZAHRA; ALBORZI, MAHBOOBEH

    2017-01-01

    Introduction: Working in the complex and ever changing healthcare settings forces the nurses and nursing students to be equipped with lifelong learning skills. One of the lifelong learning skills is self-directed learning. This study aimed to explore the M.Sc. nursing students’ self-directed learning activities. Methods: A qualitative design using conventional content analysis approach was used in this study. Semi-structured interviews were conducted with twelve Iranian M.Sc. nursing students who were selected using purposive sampling. Results: Data analysis indicated that the M.Sc. nursing students performed different activities in their self-directed learning. These activities were categorized into four main themes and ten subthemes. The main themes were “sensory perceptions”, “knowledge construction”, “problem-centered orientation”, and “interaction with others”. Conclusion: According to the findings, the M.Sc. nursing students performed different intellectual and experiential self-directed activities for promoting their learning. Besides, the students’ perseverance and inquisitiveness played an important role in their self-directed learning in the challenging clinical environments. PMID:28124019

  14. Challenges and Directions for Nursing in the Pay-for-Performance Movement

    PubMed Central

    Clarke, Sean P.; Raphael, Carol; Disch, Joanne

    2009-01-01

    Pay-for-performance (P4P) initiatives attempt to drive quality of care by aligning desired care processes and outcomes with reimbursement. P4P schemes have emerged at a time of great concern about safety and quality in health care and in the face of a growing nurse shortage. This article discusses the state of the literature linking structures for providing nursing care, measures of process heavily favored in P4P initiatives, and patient outcomes and outlines how P4P is expected to affect nursing practice. It also presents directions for managing practice settings to cope with P4P and for steering nursing’s involvement in this area of health policy. As implementation broadens, it remains to be seen whether unintended consequences emerge or whether nurses are successful in using the programs and the data sets that result from them to justify investments in nursing services and solidify the profession’s position. PMID:18562763

  15. Medical Direction in Skilled Nursing Facilities. NCHSR Research Summary Series.

    ERIC Educational Resources Information Center

    Ricci, Edmund; Tessaro, Edward

    Regulations instituted by the Department of Health, Education, and Welfare effective in 1976 require skilled nursing facilities (SNF) to provide either a physician serving as medical director, or to have an organized medical staff. This report describes how SNFs responded, and what the effects were on their operations. Descriptive data were…

  16. Advanced training for primary care and general practice nurses: enablers and outcomes of postgraduate education.

    PubMed

    Hallinan, Christine M; Hegarty, Kelsey L

    2016-01-01

    The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the

  17. Communicating with Patients Who Have Advanced Dementia: Training Nurse Aide Students

    ERIC Educational Resources Information Center

    Beer, Laura E.; Hutchinson, Susan R.; Skala-Cordes, Kristine K.

    2012-01-01

    The increase of dementia in older adults is changing how medical care is delivered. Recognizing symptoms of pain, managing behaviors, and providing quality of life for people who have advanced dementia requires a new skill set for caregivers. Researchers in this study targeted nurse aide students to test an educational module's effect on students'…

  18. University Students' Views on the Utility of Psychiatric Advance Directives

    ERIC Educational Resources Information Center

    Scheyett, Anna M.; Rooks, Adrienne

    2012-01-01

    Objective: Rates of serious mental illnesses (SMIs) among university students are increasing, and universities are struggling with how to respond to students who show SMI symptoms. Psychiatric advance directives (PADs) allow individuals, when well, to document their wishes for treatment during a psychiatric crisis. This project explored the…

  19. Globalization and advances in information and communication technologies: the impact on nursing and health.

    PubMed

    Abbott, Patricia A; Coenen, Amy

    2008-01-01

    Globalization and information and communication technology (ICT) continue to change us and the world we live in. Nursing stands at an opportunity intersection where challenging global health issues, an international workforce shortage, and massive growth of ICT combine to create a very unique space for nursing leadership and nursing intervention. Learning from prior successes in the field can assist nurse leaders in planning and advancing strategies for global health using ICT. Attention to lessons learned will assist in combating the technological apartheid that is already present in many areas of the globe and will highlight opportunities for innovative applications in health. ICT has opened new channels of communication, creating the beginnings of a global information society that will facilitate access to isolated areas where health needs are extreme and where nursing can contribute significantly to the achievement of "Health for All." The purpose of this article is to discuss the relationships between globalization, health, and ICT, and to illuminate opportunities for nursing in this flattening and increasingly interconnected world.

  20. The DNP/MPH Dual Degree: An Innovative Graduate Education Program for Advanced Public Health Nursing.

    PubMed

    Shaw, Kathy; Harpin, Scott; Steinke, Geraldine; Stember, Marilyn; Krajicek, Marilyn

    2017-03-01

    Strong professional priorities, evolving Affordable Care Act requirements, and a significantly limited public health nursing workforce prompted the University of Colorado College of Nursing to collaborate with the School of Public Health to implement one of the first Doctor of Nursing Practice/Master of Public Health dual degree programs in the nation. Federal grant funding supported the development, implementation, and evaluation of this unique post-baccalaureate dual degree program, for which there were no roadmaps, models, or best practices to follow. Several key issues emerged that serve as lessons learned in creating a new, novel higher education pathway for Advanced Public Health Nursing. This paper highlights two of those: (1) marketing, admission, and matriculation across two programs, and (2) enhancing curricula through distance coursework and interprofessional education. When collaboration with a school of public health is possible, the Doctor of Nursing Practice/Master of Public Health dual degree is an efficient way to prepare public health nurses' with the highest level of public health knowledge, practice, and leadership expertise.

  1. Factors influencing intentions to integrate tobacco education among advanced practice nursing faculty.

    PubMed

    Heath, Janie; Crowell, Nancy A

    2007-01-01

    We report on the findings of a national survey that examined factors that influence faculty's intentions to integrate tobacco education in their advanced practice nursing curricula. The addiction component of tobacco use is taking its toll on the health of 48 million smokers in the United States. Several national health authorities recommend and/or mandate that tobacco prevention and tobacco cessation be addressed at every point of entry in the health care delivery system. However, there is increasing evidence that health care providers may not be adequately prepared to meet national goals and/or standards. One hundred sixty-one advanced practice nursing faculty in the United States completed an 88-item survey regarding external factors (e.g., personal history of tobacco use, clinical practice, and current tobacco topics taught) and components of the Theory of Reasoned Action model (including perceived self-efficacy, behavioral beliefs, subjective norms, and control beliefs related to tobacco education). Descriptive statistics, chi(2) analysis, Pearson correlation, and linear regression were used to analyze the data. The findings revealed that sex (chi(2) = 7.949, P = .024), level of education (chi(2) = 26.853, P = .0005), years of academic teaching (chi(2) = 19.418, P = .013), and combined clinical and course responsibility (chi(2) = 10.430, P = .0236) were significant external (demographic) factors and that behavioral beliefs (attitude about tobacco education) demonstrated the strongest relationship with intention scores (r = 0.876, P < .0005). Overall, 62.7% of nurse practitioners reported high scores (>or=5, on a scale of 1-7) for intentions to integrate tobacco education, as compared with 37.5% of nurse midwives, 30.3% of clinical nurse specialists, and 8.7% of nurse anesthetists. This study adds to the growing body of evidence that nursing curricular gaps with tobacco education exist and that national efforts are needed to ensure that widespread changes occur

  2. To Serve the Future Hour. An Anthology on New Directions for Nursing. Pathways to Practice, Vol. 2.

    ERIC Educational Resources Information Center

    Reitt, Barbara B., Ed.

    Nurses today are faced with the problem of choosing from a proliferating array of alternatives, both when they decide what type of nursing education to pursue and when they must choose between the many occupational directions they face on graduation from nursing school. Recognizing these recent developments in both education and health, the…

  3. Clinical Research Informatics: Recent Advances and Future Directions

    PubMed Central

    2015-01-01

    Summary Objectives To summarize significant developments in Clinical Research Informatics (CRI) over the past two years and discuss future directions. Methods Survey of advances, open problems and opportunities in this field based on exploration of current literature. Results Recent advances are structured according to three use cases of clinical research: Protocol feasibility, patient identification/recruitment and clinical trial execution. Discussion CRI is an evolving, dynamic field of research. Global collaboration, open metadata, content standards with semantics and computable eligibility criteria are key success factors for future developments in CRI. PMID:26293865

  4. [Bioethical principles: planning and advance directives in Puerto Rico].

    PubMed

    Ramírez Rivera, José; Ferrer, Jorge J

    2009-01-01

    The libertarian principles of Personal Autonomy and Personalized Justice which grew mightily in the rapidly spreading young American democracy in the 18th and 19th centuries led to the development of Bioethics in the United States. The bioethical principles of Respect for Autonomy, Beneficence, non-Maleficence and Justice support the elaboration of advance directives (living will and the designation of a proxy to attend health matters) for when the patient is no longer capable to make health decisions. Advance directives can be drafted and signed in Puerto Rico with the help of a lawyer. They can also be legally prepared in a doctor's office or in a hospital if witnessed by a doctor and two persons who will not benefit from the patient's demise or are directly involved in his/her care). We present a model for advance directives which may be executed in a doctor's office or a hospital. The model fulfills the legal requirements of Puerto Rico Law 160 which became effective November 2001. It also fulfills requirements of the Patients Self-Determination Act that became effective in 1991.The document also contains standard options for organ donations. We discuss the fundamental bioethical principles which have given root to the development of the advance directives. We suggest that it may be economically advantageous to health insurance carriers to compensate physicians who help their patients in the execution of a valid document. The existence of this document may help prevent the large expenses associated with inappropriate admissions to intensive care of patients at the end-of-life.

  5. The transition to practice of Direct Entry Clinical Nurse Leader graduates.

    PubMed

    Shatto, Bobbi; Meyer, Geralyn; Delicath, Timothy A

    2016-07-01

    This study looks at Direct Entry Clinical Nurse Leader graduates and how their transition to practice experiences develops over time as well as factors influencing their transition. Graduates were surveyed at graduation, three, six and 12 months. Seventeen participated; eight completed all surveys. Most were from the Millennial generation. The survey consisted of two parts: school satisfaction and the Casey-Fink Graduate Nurse Experience Scale. The results showed the Casey-Fink total score at 12 months was 0.75 points higher than at three months; suggesting a positive transition. The highest score occurred at six months which conversely had the lowest levels of satisfaction with both educational experience and intent to stay in their current role. Despite having 850 precepted/mentored clinical hours, 57.1% of these graduates stated they felt unprepared for the reality of nursing after 12 months. Regardless of feeling unprepared, the results suggest these students displayed a positive transition to practice. At 12 months, 88.2% were still with their first employers which contrasted the results of Casey-Fink and other studies of Millennial gradate nurses, which showed higher actual and intent to leave results. This study suggests that Direct Entry Clinical Nurse Leader students do indeed transition to practice more positively than traditional nursing graduates.

  6. Health Care Reform and the Federal Transformation Initiatives: Capitalizing on the Potential of Advanced Practice Psychiatric Nurses

    PubMed Central

    Hanrahan, Nancy P.; Delaney, Kathleen; Merwin, Elizabeth

    2012-01-01

    In the last decade the US federal government proposed a transformation vision of mental health service delivery; patient-centered, evidence-based and recovery oriented treatment models. Health care reform brings additional expectations for innovation in mental/substance use service delivery, particularly the idea of creating systems where physical health, mental health and substance use treatment is fully integrated. Psychiatric nurses, as one of the four core US mental health professions, have the potential to play a significant role in the both the transformation initiative and health care reform vision. However, psychiatric nurses, particularly advanced practice psychiatric nurses, are an untapped resource due in part to significant state regulatory barriers that limit their scope of practice in many states. The purpose of this paper is to document what is currently known about advanced practice psychiatric nurses and discuss policy implications for tapping into the strengths of this workforce. Strategies for facilitating utilization of advanced practice psychiatric nurses discussed. PMID:21233135

  7. A closer look at the "supervision" and "direction" of certified registered nurse anesthetists.

    PubMed

    Schreiber, Rita; MacDonald, Marjorie

    2008-03-01

    A growing shortage of anesthesiologists in Canada has prompted discussion of how anesthesia provision can be expanded. Canadian anesthesiologists generally support a team approach in which physicians supervise alternative providers. In the U.S., nurses have worked as anesthetists for over 150 years, and their experiences of different models of anesthesia provision provide valuable insights into the potential pitfalls of the team approach as well as the benefits of autonomous nurse anesthetist roles. The authors conducted a qualitative study of the anesthesia team and the role of nurse anesthesia practice in the U.S., and here they present a summary of some of their preliminary findings and the implications for evolving models of care in Canada. Inefficiencies associated with the medical supervision and direction of Certified Registered Nurse Anesthetists are discussed.

  8. Exploring the district nurse role in facilitating individualised advance care planning.

    PubMed

    Boot, Michelle

    2016-03-01

    Health-care policy recognises the importance of engaging people in making decisions related to the management of their health. Advance care planning (ACP) offers a framework for decision making on end-of-life care. There are positive indicators that ACP enables health professionals to meet people's preferences. However, there are reports of insensitive attempts to engage people in end-of-life care decision making. District nurses are in the ideal position to facilitate ACP, as they have the opportunity to build relationships with the people they are caring for--an antecedent to sensitive ACP--and in recognising and fulfilling this role, they could ameliorate the risk of insensitive ACP. Distric nurse leaders also have a role to play in ensuring that organisational and environmental factors support appropriate ACP facilitation including: training, fostering a team culture that empowers district nurses to recognise and meet their ACP role, and advocating for appropriate ACP evaluation outcome measures.

  9. Barriers to advanced practice registered nurse scope of practice: issue analysis.

    PubMed

    Villegas, Whitney J; Allen, Patricia E

    2012-09-01

    Advanced practice registered nurses (APRNs) have the unique potential to affect the changing needs of health care in the United States, but are restricted in care provision by varying state regulations and reimbursement policies. Although research shows APRN care to be safe, cost-effective, and of high quality, most medical professional organizations continue to oppose the removal of scope-of-practice barriers, citing patient safety concerns. Nursing organizations at the state and national levels have already begun to invest the time and resources needed for policy change. However, empirical evidence of APRN quality of care must be shared with policymakers, funding entities, and the public. Additionally, support must be garnered from the public and other health care disciplines. Scope-of-practice policy change will occur through the emergence of strong individuals within nursing professional organizations and the joining together of organizations to form one voice.

  10. Advances in generating functional diversity for directed protein evolution.

    PubMed

    Shivange, Amol V; Marienhagen, Jan; Mundhada, Hemanshu; Schenk, Alexander; Schwaneberg, Ulrich

    2009-02-01

    Despite advances in screening technologies, only a very small fraction of theoretical protein sequence can be sampled in directed evolution experiments. At the current state of random mutagenesis technologies mutation frequencies have often been adjusted to values that cause a limited number of amino acid changes (often one to four amino acid changes per protein). For harvesting the power of directed evolution algorithms it is therefore important that generated mutant libraries are rich in diversity and enriched in active population. Insufficient knowledge about protein traits, mutational robustness of protein folds and technological limitations in diversity generating methods are main challenges for managing the complexity of protein sequence space. This review covers computational and experimental advances for high quality mutant library generation that have been achieved in the past two years.

  11. Conceptual and methodological advances in cell-free directed evolution

    PubMed Central

    Dodevski, Igor; Markou, George C.; Sarkar, Casim A.

    2015-01-01

    Although cell-free directed evolution methods have been used to engineer proteins for nearly two decades, selections on more complex phenotypes have largely remained in the domain of cell-based engineering approaches. Here, we review recent conceptual advances that now enable in vitro display of multimeric proteins, integral membrane proteins, and proteins with an expanded amino acid repertoire. Additionally, we discuss methodological improvements that have enhanced the accessibility, efficiency, and robustness of cell-free approaches. Coupling these advances with the in vitro advantages of creating exceptionally large libraries and precisely controlling all experimental conditions, cell-free directed evolution is poised to contribute significantly to our understanding and engineering of more complex protein phenotypes. PMID:26093059

  12. Advances and future directions of research on spectral methods

    NASA Technical Reports Server (NTRS)

    Patera, A. T.

    1986-01-01

    Recent advances in spectral methods are briefly reviewed and characterized with respect to their convergence and computational complexity. Classical finite element and spectral approaches are then compared, and spectral element (or p-type finite element) approximations are introduced. The method is applied to the full Navier-Stokes equations, and examples are given of the application of the technique to several transitional flows. Future directions of research in the field are outlined.

  13. [Advance directives: what are the ethical choices in Belgium?].

    PubMed

    Delfosse, Marie-Luce

    2008-01-01

    In Belgium, three laws intervene notions close to advanced directives: the law of 13th June 1986 referring to organ removal and transplant, the law of 28 May 2002 concerning euthanasia and finally the law of 22 August 2002 relating to patients' rights. Which are the main ethical stakes of these laws? This article tries to answer this question and it will show the common stake of the last two laws: the respect of the patient's moral integrity.

  14. Proactive nurse management guidelines for managing intensive chemotherapy regimens in patients with advanced gastric cancer.

    PubMed

    Baker, J; Ajani, J A

    2008-07-01

    Patients with advanced gastric cancer have a poor prognosis. Intensive chemotherapy regimens may be effective for the treatment of this disease but may be associated with a significant number of severe adverse events. Optimal management of these adverse events can improve outcome for the patient. Currently, there is little information in the literature about the nursing management of this particular group of patients. This American study involved the nursing management of all patients with gastric or gastroesophageal cancer enrolled in clinical trials at a single center. Patients had close contact with research nurses and received education about adverse events and how to deal with them. Patients completed a detailed treatment diary for each cycle of treatment. Protocols were established for the management of emergent adverse events. The guidelines developed during this study could help to underpin the role of the specialist oncology nurse and improve the management of patients undergoing intensive chemotherapy for gastric and gastroesophageal cancer, with the potential of improving outcome, or at least quality of life, for the patients. The nurses' role should be pivotal in the management of intensive chemotherapy for gastric and gastroesophageal cancer.

  15. Implications for Advanced Nursing Practice in the Patient with Heat Stress

    DTIC Science & Technology

    1993-05-01

    systemic vascular resistance), while elderly patients are hypodynamic (increased heart rate, decreased cardiac output and decreased systemic vascular...resistance). By the time elderly patients are seen, massive volume deficits may exist, requiring hemodynamic monitoring to differentiate pump...TITLE AND SUBTITLE 5. FUNDING NUMBERS Implications for Advanced Nursing Practice in the Patient with Heat Stress 6. AUTHOR(S) Patricia A Skelton S 7

  16. Moral distress in nurses providing direct care on inpatient oncology units.

    PubMed

    Sirilla, Janet

    2014-10-01

    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.

  17. Canadian advanced life support capacities and future directions

    NASA Astrophysics Data System (ADS)

    Bamsey, M.; Graham, T.; Stasiak, M.; Berinstain, A.; Scott, A.; Vuk, T. Rondeau; Dixon, M.

    2009-07-01

    Canada began research on space-relevant biological life support systems in the early 1990s. Since that time Canadian capabilities have grown tremendously, placing Canada among the emerging leaders in biological life support systems. The rapid growth of Canadian expertise has been the result of several factors including a large and technically sophisticated greenhouse sector which successfully operates under challenging climatic conditions, well planned technology transfer strategies between the academic and industrial sectors, and a strong emphasis on international research collaborations. Recent activities such as Canada's contribution of the Higher Plant Compartment of the European Space Agency's MELiSSA Pilot Plant and the remote operation of the Arthur Clarke Mars Greenhouse in the Canadian High Arctic continue to demonstrate Canadian capabilities with direct applicability to advanced life support systems. There is also a significant latent potential within Canadian institutions and organizations with respect to directly applicable advanced life support technologies. These directly applicable research interests include such areas as horticultural management strategies (for candidate crops), growth media, food processing, water management, atmosphere management, energy management, waste management, imaging, environment sensors, thermal control, lighting systems, robotics, command and data handling, communications systems, structures, in-situ resource utilization, space analogues and mission operations. With this background and in collaboration with the Canadian aerospace industry sector, a roadmap for future life support contributions is presented here. This roadmap targets an objective of at least 50% food closure by 2050 (providing greater closure in oxygen, water recycling and carbon dioxide uptake). The Canadian advanced life support community has chosen to focus on lunar surface infrastructure and not low Earth orbit or transit systems (i.e. microgravity

  18. Advanced practice nursing for enduring health needs management: a global perspective.

    PubMed

    Koskinen, Liisa; Mikkonen, Irma; Graham, Iain; Norman, Linda D; Richardson, Jim; Savage, Eileen; Schorn, Mavis

    2012-07-01

    Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation.

  19. Directions for advanced use of nuclear power in century XXI

    SciTech Connect

    Walter, C E

    1999-05-01

    Nuclear power can provide a significant contribution to electricity generation and meet other needs of the world and the US during the next century provided that certain directions are taken to achieve its public acceptance. These directions include formulation of projections of population, energy consumption, and energy resources over a responsible period of time. These projections will allow assessment of cumulative effects on the environment and on fixed resources. Use of fossil energy resources in a century of growing demand for energy must be considered in the context of long-term environmental damage and resource depletion. Although some question the validity of these consequences, they can be mitigated by use of advanced fast reactor technology. It must be demonstrated that nuclear power technology is safe, resistant to material diversion for weapon use, and economical. An unbiased examination of all the issues related to energy use, especially of electricity, is an essential direction to take.

  20. Bilingual teaching in nursing education in China: evolution, status, and future directions.

    PubMed

    He, Wei; Xu, Yu; Zhu, Jianhua

    2011-09-01

    Based on Chinese published literature and personal observations, this article reviews the history of bilingual teaching in nursing education in China, describes its current status and challenges, and predicts its future directions. Bilingual teaching in nursing education enjoys increasing popularity in China. The major factors that affect bilingual teaching are bilingual educators, students' English-language levels, bilingual teaching materials, and teaching models. Based on surveys of nursing schools, the English-language proficiency of the nursing educators varies greatly. The main issues with the teaching methods lie in over-translation, cramming, and limited interaction between the students and the teachers. Despite relatively inadequate English-language proficiency among Chinese nursing students, their interest can be strengthened greatly if international exchanges are available and promoted. Bilingual textbooks are more suitable in China's national context because of pricing and relevance. Although immersive bilingual teaching is the ideal, it is more feasible to begin with infiltrative bilingual teaching and move progressively towards increased English-language penetration. Future directions for improving bilingual teaching include training teaching faculty members, strengthening international exchanges, providing better bilingual study atmospheres, and gradually implementing bilingual textbooks.

  1. Narrative pedagogy and simulation: future directions for nursing education.

    PubMed

    Walsh, Mike

    2011-05-01

    Narrative pedagogy has been developed over the last decade in nursing as a means of complementing a conventional content and competency driven pedagogy. It focuses attention on the human experience of health care by deriving shared meanings from interpretation of stories. This allows students to explore the different perspectives of those involved. The emotional experiences of participants can be understood, conventional wisdom challenged and new knowledge emerge as students work together to construct their learning. Individual stories are embedded within the narrative and teachers have successfully used literature and film as narratives to help them explore the meaning of health care with students. Modern technology has opened up a new range of electronic narratives such as virtual simulation. These are considered and rejected as devices for a health care narrative due to their dehumanized and unrealistic nature. However it is argued that a multimedia online simulation of a typical neighbourhood can achieve the goal of providing a suitable narrative. Human actors replace avatars and real world settings replace gaming environments as the stories of people in this community are related and used to support narrative pedagogy. An example of such a narrative developed jointly in the UK and Canada is discussed.

  2. Can the Institute of Medicine trump the dominant logic of nursing? Leading change in advanced practice education.

    PubMed

    Dreher, Melanie C; Clinton, Patricia; Sperhac, Arlene

    2014-01-01

    The Institute of Medicine (IOM; 2010) has called for a transformation of the nursing profession to lead the redesign of health care in the United States. It acknowledges the need for profound change in nursing education, particularly advanced practice education, to produce the next generation of leaders in sufficient quantity to expand access, improve quality, and reduce cost. Although the IOM provides welcome validation of nursing's significant role, most of the recommendations are not new and have been advocated by nurse educators for decades. What has prevented us from creating the nimble and responsive educational programs that would ensure a sufficient corpus of advanced practice nurses with the relevant knowledge and skill to transform our ailing health system? Conceptualizing nursing as a complex, adaptive system (J.W. Begun and K. White, 1997), this article explores three examples of the dominant logic, grounded in a historical legacy that has kept the nursing profession from realizing its promise as a potent force: (a) the continuing preference for experience over education, (b) the belief that only nurses can teach nurses, and (c) the hegemony of the research doctorate.

  3. Understanding Faculty and Non-Traditional Student Perceptions of Self-Directed Learning in a Practical Nursing Program

    ERIC Educational Resources Information Center

    Rogers, Carmen

    2013-01-01

    This study was designed to identify and investigate nursing faculty and student perspectives of self-directed learning in a practical nursing program. It also explored the degree to which student's perceptions of self-directed learning exhibited factors consistent with that of critical thinking. This study is important because self-directed…

  4. Implementing psychiatric advance directives: service provider issues and answers.

    PubMed

    Srebnik, Debra; Brodoff, Lisa

    2003-01-01

    Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to document treatment preferences in advance of periods of incapacity. This article presents and responds to issues most frequently raised by service providers when planning for implementation of PADs. Issues discussed include access to PADs; competency to execute PADs; the relationship of PADs to standards of care, resource availability, and involuntary treatment; roles of service providers and others in execution of PADs; timeliness and redundancy of PAD information; consumer expectations of PADs; complexity of PADs; revocation and "activation"; legal enforceability of PADs; the role and powers of agents; liability for honoring and not honoring PADs; and use of PADs to consent for release of health care information. Recommendations are made for training staff and consumers, consideration of statute development, and methods to reduce logistical, attitudinal, and system barriers to effective use of PADs.

  5. Assessing readiness for self-directed learning within a non-traditional nursing cohort.

    PubMed

    Phillips, Brian N; Turnbull, Beverley J; He, Flora X

    2015-03-01

    Increasing deregulation of the Australian tertiary system has led to changes in entry behaviours anticipated in non-traditional student cohorts. Many nursing students are returning to formal studies later in their lives seeking a career change. Accessibility and flexible study paths make external study increasingly attractive. However external studies require a level of commitment and willingness to develop self-direction and a capacity for resilience. This study sought to elicit the level of self-directed learning readiness (SDLR) among undergraduate nursing students currently enrolled at a bachelor level, and to elicit what differences existed in the levels of SDLR in relation to age, gender, academic year, and previous qualifications. An online survey questionnaire was utilised based on the Self-directed Learning Readiness Scale for Nursing Education. In contrast to earlier work, the participant profile in this study was predominantly non-traditional and captured participants from all three years of the nursing programme. Results found no significant age or gender differences. First year students demonstrated lower levels of self-directed learning readiness. However, unexpected results were demonstrated in the survey subscales in relation to previous qualifications. Participants who already held post-graduate qualifications showed lower scores for Self-Management than those who held diploma qualifications, while students who already held a bachelor's degree had the highest scores in Desire for Learning. The study findings suggest that universities should not assume that SDL capability is dependent on mature age or length of exposure to tertiary study.

  6. Exploring the use of standardized patients for simulation-based learning in preparing advanced practice nurses.

    PubMed

    Kowitlawakul, Yanika; Chow, Yeow Leng; Salam, Zakir Hussian Abdul; Ignacio, Jeanette

    2015-07-01

    The use of standardized patients for simulation-based learning was integrated into the Master of Nursing curriculum in the 2012-2013 academic year. The study aimed to explore the Master of Nursing students' experiences with and perceptions of using standardized patients in simulations, and to identify the students' learning needs in preparing to become advanced practice nurses. The study adopted an exploratory descriptive qualitative design, using a focus group interview. The study was conducted at a university in Singapore. Seven Master of Nursing students who were enrolled in the Acute Care Track of Master of Nursing program in the 2012-2013 academic year participated in the study. The data were gathered at the end of the first semester. Content analysis was used to analyze the data. Three main categories - usefulness, clinical limitations, and realism - were identified in the study. The results revealed that the students felt using standardized patients was useful and realistic for developing skills in history taking, communication, and responding to an emergency situation. On the other hand, they found that the standardized patients were limited in providing critical signs and symptoms of case scenarios. To meet the learning objectives, future development and integration of standardized patients in the Master of Nursing curriculum might need to be considered along with the use of a high-fidelity simulator. This can be an alternative strategy to fill the gaps in each method. Obviously, using standardized patients for simulation-based learning has added value to the students' learning experiences. It is highly recommended that future studies explore the impact of using standardized patients on students' performance in clinical settings.

  7. Novel interfaces for light directed neuronal stimulation: advances and challenges

    PubMed Central

    Bareket-Keren, Lilach; Hanein, Yael

    2014-01-01

    Light activation of neurons is a growing field with applications ranging from basic investigation of neuronal systems to the development of new therapeutic methods such as artificial retina. Many recent studies currently explore novel methods for optical stimulation with temporal and spatial precision. Novel materials in particular provide an opportunity to enhance contemporary approaches. Here we review recent advances towards light directed interfaces for neuronal stimulation, focusing on state-of-the-art nanoengineered devices. In particular, we highlight challenges and prospects towards improved retinal prostheses. PMID:24872704

  8. Novel interfaces for light directed neuronal stimulation: advances and challenges.

    PubMed

    Bareket-Keren, Lilach; Hanein, Yael

    2014-01-01

    Light activation of neurons is a growing field with applications ranging from basic investigation of neuronal systems to the development of new therapeutic methods such as artificial retina. Many recent studies currently explore novel methods for optical stimulation with temporal and spatial precision. Novel materials in particular provide an opportunity to enhance contemporary approaches. Here we review recent advances towards light directed interfaces for neuronal stimulation, focusing on state-of-the-art nanoengineered devices. In particular, we highlight challenges and prospects towards improved retinal prostheses.

  9. Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses

    PubMed Central

    Murray, Bethany; McNew, Brittany

    2015-01-01

    Abstract Purpose This review article provides an overview of the frequency, burden of illness, diagnosis, and treatment of bipolar disorder (BD) from the perspective of the advanced practice nurses (APNs). Data sources PubMed searches were conducted using the following keywords: “bipolar disorder and primary care,” restricted to dates 2000 to present; “bipolar disorder and nurse practitioner”; and “bipolar disorder and clinical nurse specialist.” Selected articles were relevant to adult outpatient care in the United States, with a prioritization of articles written by APNs or published in nursing journals. Conclusions BD has a substantial lifetime prevalence in the population at 4%. Because the manic or depressive symptoms of BD tend to be severe and recurrent over a patient's lifetime, the condition is associated with significant burden to the individual, caregivers, and society. Clinician awareness that BD may be present increases the likelihood of successful recognition and appropriate treatment. A number of pharmacological and nonpharmacological treatments are available for acute and maintenance treatments, with the prospect of achieving reduced symptom burden and increased functioning for many patients. Implications for practice Awareness of the disease burden, diagnostic issues, and management choices in BD has the potential to enhance outcome in substantial proportions of patients. PMID:26172568

  10. Recent advances in high-performance direct methanol fuel cells

    SciTech Connect

    Narayanan, S.R.; Chun, W.; Valdez, T.I.

    1996-12-31

    Direct methanol fuel cells for portable power applications have been advanced significantly under DARPA- and ARO-sponsored programs over the last five years. A liquid-feed direct methanol fuel cell developed under these programs, employs a proton exchange membrane as electrolyte and operates on aqueous solutions of methanol with air or oxygen as the oxidant. Power densities as high as 320 mW/cm{sup 2} have been demonstrated. Demonstration of five-cell stack based on the liquid-feed concept have been successfully performed by Giner Inc. and the Jet Propulsion Laboratory. Over 2000 hours of life-testing have been completed on these stacks. These fuel cells have been also been demonstrated by USC to operate on alternate fuels such as trimethoxymethane, dimethoxymethane and trioxane. Reduction in the parasitic loss of fuel across the fuel cell, a phenomenon termed as {open_quotes}fuel crossover{close_quotes} has been achieved using polymer membranes developed at USC. As a result efficiencies as high as 40% is considered attainable with this type of fuel cell. The state-of-development has reached a point where it is now been actively considered for stationary, portable and transportation applications. The research and development issues have been the subject of several previous articles and the present article is an attempt to summarize the key advances in this technology.

  11. Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue

    PubMed

    Rudner Lugo, Nancy

    2016-05-04

    In the United States, Advanced Practice Registered Nurse (APRN) regulations are determined at the state level, through legislation and rule making. The lack of an evidence base to APRN regulation has resulted in a patchwork of varied regulations and requirements for nurse practitioners. The author begins this article by reviewing the history of the Equal Rights Amendment (ERA) in the United States and describing her study that assessed APRN fullpractice authority in states that ratified the ERA versus states that opposed it. She presents the study findings, limitations of the comparison, and discussion of the findings and implications. In conclusion, the findings demonstrated that progress toward full APRN practice will require building strategies for political support and framing the need to update APRN regulations in a manner that aligns with each state’s social and political values.

  12. [Towards universal access to health care: incorporation of advanced practice nurses in primary care].

    PubMed

    Aguirre-Boza, Francisca; Achondo, Bernardita

    2016-10-01

    To move towards universal access to health, the Pan American Health Organization recommends strengthening primary health care (PHC). One of the strategies is to increase the number qualified professionals, both medical and non-medical, working in PHC. In Chile there is a lack of professionals in this level of care, hampering the provision of health. Physicians still prefer secondary and tertiary levels of health. International experience has shown that advanced practice nurses (APN), specialists in PHC are cost-effective professionals able to deliver a complete and quality care to patients. Strong evidence demonstrates the benefits that APN could provide to the population, delivering nursing care that incorporates medical tasks, for example in patients with chronic diseases, allowing greater availability of medical hours for patients requiring more complex management. The success in the implementation of this new role requires the support of the health team, especially PHC physicians, endorsing and promoting the benefits of the APN for the population.

  13. Do Spanish Hospital Professionals Educate Their Patients About Advance Directives? : A Descriptive Study in a University Hospital in Madrid, Spain.

    PubMed

    Pérez, María; Herreros, Benjamín; Martín, M Dolores; Molina, Julia; Kanouzi, Jack; Velasco, María

    2016-06-01

    It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives (ADs). The objective of this research was to determine the frequency of hospital-based physicians' and nurses' engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses (77 per cent), chronic diseases (61 per cent), and elderly patients (43 per cent). Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age.

  14. Providing a navigable route for acute medicine nurses to advance their practice: a framework of ascending levels of practice.

    PubMed

    Lees-Deutsch, Liz; Christian, Jan; Setchfield, Ian

    2016-01-01

    This article conveys concerns raised by delegates at the International SAM Conference (Manchester, 2015) regarding how to advance nursing practice in acute medicine. It endeavors to capture the essence of 'how to advance practice' and 'how to integrate advanced practice' within the workforce structures of an acute medicine unit (AMU). It addresses the production of tacit knowledge and the recognition and integration of this to developing the nursing workforce. The current context of NHS efficiencies and recruitment issues emphasize the value of retaining tacit knowledge. Uniquely, this article offers an early conceptual framework through which levels of advancement and potential transition points to advance nursing practice in acute medicine are articulated. Determining how to advance requires identification of prior accomplishments such as, tacit knowledge, experiential learning, CPD, specialist courses and management experience. This requires nurses to make judicious decisions to advance their practice and the distinction between 'amassing experience' and 'career progression'. It aims to stimulate thinking around the practicalities of advancement, the value of tacit knowledge and potential realization through the framework trajectory.

  15. Advances in direct and diffraction methods for surface structural determination

    NASA Astrophysics Data System (ADS)

    Tong, S. Y.

    1999-08-01

    I describe recent advances in low-energy electron diffraction holography and photoelectron diffraction holography. These are direct methods for determining the surface structure. I show that for LEED and PD spectra taken in an energy and angular mesh, the relative phase between the reference wave and the scattered wave has a known geometric form if the spectra are always taken from within a small angular cone in the near backscattering direction. By using data in the backscattering small cone at each direction of interest, a simple algorithm is developed to invert the spectra and extract object atomic positions with no input of calculated dynamic factors. I also describe the use of a convergent iterative method of PD and LEED. The computation time of this method scales as N2, where N is the dimension of the propagator matrix, rather than N3 as in conventional Gaussian substitutional methods. Both the Rehr-Albers separable-propagator cluster approach and the slab-type non-separable approach can be cast in the new iterative form. With substantial savings in computational time and no loss in numerical accuracy, this method is very useful in applications of multiple scattering theory, particularly for systems involving either very large unit cells (>300 atoms) or where no long-range order is present.

  16. [Challenges and opportunities: contributions of the Advanced Practice Nurse in the chronicity. Learning from experiences].

    PubMed

    Appleby, Christine; Camacho-Bejarano, Rafaela

    2014-01-01

    Undoubtedly, our society is facing new economic, political, demographic, social and cultural challenges that require healthcare services able to meet the growing health needs of the population, especially in dealing with chronic conditions. In this new context, some countries such as the United Kingdom have made a firm commitment to develop new models for chronic patients care based on the introduction of new figures of Advanced Practice Nurses, which includes 4 cornerstones of professional practice: advanced clinical skills, clinical management, teaching and research. The implementation of this new figures implies a redefinition of professional competencies and has its own accreditation system and a specific catalogue of services adapted to the population requirements, in order to provide chronic care support from Primary Care settings. This trajectory allows us analysing the process of design and implementation of these new models and the organizational structure where it is integrated. In Spain, there are already experiences in some regions such as Andalucia and the Basque Country, focused on the creation of new advanced nursing roles. At present, it is necessary to consider suitable strategic proposals for the complete development of these models and to achieve the best results in terms of overall health and quality of life of patients with chronic conditions, improving the quality of services and cost-effectiveness through a greater cohesion and performance of healthcare teams towards the sustainability of healthcare services and patient satisfaction.

  17. Advance directives among people living with HIV: room for improvement.

    PubMed

    Barocas, Joshua A; Erlandson, Kristine M; Belzer, Blythe K; Hess, Timothy; Sosman, James

    2015-01-01

    While HIV has become a largely chronic disease, age-associated comorbidities are prevalent in people living with HIV (PLWH). Therefore, PLWH are appropriate for advance care planning (ACP) and advance directives (ADs) completion. We sought to characterize AD completion among outpatient PLWH. We conducted a retrospective chart review of PLWH who receive their routine care at the University of Wisconsin HIV clinic. Data were extracted from the electronic health record. Variables were entered into a stepwise multivariate logistic regression model to assess which factors were independently associated with AD completion. Five hundred and eighty eight charts were reviewed. Eighty-one percent of subjects were male and 72% were white; mean age was 46.8 years. ADs were completed by 134 subjects and 6.7% of those were completed at the HIV clinic. In the final multivariate model, those who had completed an AD were more likely to be older than age 45; ever been diagnosed with AIDS; have cardiovascular disease, neurologic disorder, chronic kidney disease, or malignancy. In this study, a small percentage of patients had documented ADs, with only a small proportion completed in the HIV clinic. The HIV clinic is an underutilized resource to offer ACP. Interventions are needed to provide the necessary ACP resources for PLWH.

  18. The Advanced Dementia Prognostic Tool (ADEPT): A Risk Score to Estimate Survival in Nursing Home Residents with Advanced Dementia

    PubMed Central

    Mitchell, Susan L.; Miller, Susan C.; Teno, Joan M.; Davis, Roger B.; Shaffer, Michele L.

    2010-01-01

    Context Estimating life expectancy is challenging in advanced dementia. Objectives To create a risk score to estimate survival in nursing home (NH) residents with advanced dementia. Methods This was a retrospective cohort study performed in the setting of all licensed US NHs. Residents with advanced dementia living in US NHs in 2002 were identified using Minimum Data Set (MDS) assessments. Mortality data from Medicare files were used to determine 12-month survival. Independent variables were selected from the MDS. Cox proportional hazards regression was used to model survival. The accuracy of the final model was assessed using the area under the receiver operating characteristic curve (AUROC). To develop a risk score, points were assigned to variables in the final model based on parameter estimates. Residents meeting hospice eligibility guidelines for dementia, based on MDS data, were identified. The AUROC assessed the accuracy of hospice guidelines to predict six-month survival. Results Over 12 months, 40.6% of residents with advanced dementia (n=22,405) died. Twelve variables best predicted survival: length of stay, age, male, dyspnea, pressure ulcers, total functional dependence, bedfast, insufficient intake, bowel incontinence, body mass index, weight loss, and congestive heart failure. The AUROC for the final model was 0.68. The risk score ranged from 0–32 points (higher scores indicate worse survival). Only 15.9% of residents met hospice eligibility guidelines for which the AUROC predicting six-month survival was 0.53. Conclusion A mortality risk score derived from MDS data predicted six-month survival in advanced dementia with moderate accuracy. The predictive ability of hospice guidelines, simulated with MDS data, was poor. PMID:20621437

  19. Influenza vaccination and decisional conflict among regulated and unregulated direct nursing care providers in long-term-care homes.

    PubMed

    Sullivan, Shannon M; Pierrynowski-Gallant, Donna; Chambers, Larry; O'Connor, Annette; Bowman, Sherry; McNeil, Shelly; Strang, Robert; Knoefel, Frank

    2008-02-01

    The purpose of this study was to determine whether direct nursing care providers have decisional conflict about receiving influenza vaccinations and characteristics associated with decisional conflict. The researchers used a self-administered questionnaire mailed to direct nursing care providers in two long-term-care organizations. Most direct nursing care providers in both organizations (80% and 93%, respectively) intended to get the influenza vaccine. Unregulated direct nursing care providers had more decisional conflict than regulated providers, especially related to feeling uninformed about the pros and cons of influenza vaccination. Unclear valuing of the pros and cons of influenza vaccination was related to the age of the direct care providers in both organizations. Decisional conflict and influenza vaccination practices may be determined, in part, by age and by the culture of a health care organization. A decision aid to improve knowledge and clarify values may improve decision quality and increase influenza vaccination rates.

  20. Recovery Act: Advanced Direct Methanol Fuel Cell for Mobile Computing

    SciTech Connect

    Fletcher, James H.; Cox, Philip; Harrington, William J; Campbell, Joseph L

    2013-09-03

    ABSTRACT Project Title: Recovery Act: Advanced Direct Methanol Fuel Cell for Mobile Computing PROJECT OBJECTIVE The objective of the project was to advance portable fuel cell system technology towards the commercial targets of power density, energy density and lifetime. These targets were laid out in the DOE’s R&D roadmap to develop an advanced direct methanol fuel cell power supply that meets commercial entry requirements. Such a power supply will enable mobile computers to operate non-stop, unplugged from the wall power outlet, by using the high energy density of methanol fuel contained in a replaceable fuel cartridge. Specifically this project focused on balance-of-plant component integration and miniaturization, as well as extensive component, subassembly and integrated system durability and validation testing. This design has resulted in a pre-production power supply design and a prototype that meet the rigorous demands of consumer electronic applications. PROJECT TASKS The proposed work plan was designed to meet the project objectives, which corresponded directly with the objectives outlined in the Funding Opportunity Announcement: To engineer the fuel cell balance-of-plant and packaging to meet the needs of consumer electronic systems, specifically at power levels required for mobile computing. UNF used existing balance-of-plant component technologies developed under its current US Army CERDEC project, as well as a previous DOE project completed by PolyFuel, to further refine them to both miniaturize and integrate their functionality to increase the system power density and energy density. Benefits of UNF’s novel passive water recycling MEA (membrane electrode assembly) and the simplified system architecture it enabled formed the foundation of the design approach. The package design was hardened to address orientation independence, shock, vibration, and environmental requirements. Fuel cartridge and fuel subsystems were improved to ensure effective fuel

  1. The Research Doctorate in Nursing: The PhD.

    PubMed

    Rice, David

    2016-03-01

    When nurses are considering an advanced degree beyond the master's level of educational preparation, a number of considerations may direct the decision-making process. The doctorate of philosophy (PhD) in nursing is a research degree that will well serve nurses who have the desire to apply theory and develop formal programs of research, become faculty of nursing, combine clinical practice with formal research, and advance through professional leadership in the ranks of hospitals and health systems organizations. 
.

  2. Nurse-Administered, Gut-Directed Hypnotherapy in IBS: Efficacy and Factors Predicting a Positive Response.

    PubMed

    Lövdahl, Jenny; Ringström, Gisela; Agerforz, Pia; Törnblom, Hans; Simrén, Magnus

    2015-07-01

    Hypnotherapy is an effective treatment in irritable bowel syndrome (IBS). It is often delivered by a psychotherapist and is costly and time consuming. Nurse-administered hypnotherapy could increase availability and reduce costs. In this study the authors evaluate the effectiveness of nurse-administered, gut-directed hypnotherapy and identify factors predicting treatment outcome. Eighty-five patients were included in the study. Participants received hypnotherapy by a nurse once/week for 12 weeks. Patients reported marked improvement in gastrointestinal (GI) and extra-colonic symptoms after treatment, as well as a reduction in GI-specific anxiety, general anxiety, and depression. Fifty-eight percent were responders after the 12 weeks treatment period, and of these 82% had a favorable clinical response already at week 6. Women were more likely than men to respond favorably to the treatment. Nurse-administered hypnotherapy is an effective treatment for IBS. Being female and reporting a favorable response to treatment by week 6 predicted a positive treatment response at the end of the 12 weeks treatment period.

  3. Creating a framework for clinical nursing practice to advance in the West Midlands region.

    PubMed

    Dunn, L; Morgan, E

    1998-05-01

    The West Midlands Regional Health Authority identified a lack of opportunities for nurses to develop advanced clinical practice through a recognized programme at Postgraduate diploma/Masters degree level. Education for clinical practice must be equally grounded in theory and practice. Advanced clinical practice requires more than just skills acquisition, it has a much wider remit incorporating elements of clinical expertise and higher level decision making, research awareness, teaching and role modelling, informing policy making and leading in the provision of patient care within individual Trusts. This initiative has encouraged universities, trusts and provider units to work together to identify and prepare students and staff for their changes in role, and to review existing boundaries for practice which will enable new approaches to team work and the provision of holistic patient care.

  4. A Review and Critique of Advances in Nursing Science Articles That Focus on Sexual Health and Sexual Rights: A Call to Leadership and Policy Development.

    PubMed

    Rew, Lynn; Thurman, Whitney; McDonald, Kari

    Sexual health and sexual rights are integral to nursing science but ignored in nursing publications. We searched Advances in Nursing Science for prevalence of these topics. Fifteen articles (1.3%) met our criteria. No nursing theories were used as frameworks, and few concrete suggestions were made for further theory development. Discussion of sociopolitical influences on sexual health and/or sexual rights was limited, mostly unrelated to health care. Information to influence nursing practice, theory development, further research, or policy across the life span, for both males and females, and for variant-gender individuals, was limited. We urge authors to contribute further to this field of discourse in nursing.

  5. Developing a professional poster: four "ps" for advanced practice nurses to consider.

    PubMed

    Bindon, Susan L; Davenport, Joan M

    2013-01-01

    Professional posters play an important role in the dissemination of knowledge and the professional development of advanced practice nurses, graduate students, and clinical faculty. Posters should be considered an integral component in communication of professional work in practice, research, and education. The invitation to submit a poster abstract is an important opportunity for clinicians and faculty alike to consider. Though sometimes misperceived as less prestigious than a podium presentation, posters add a unique element to professional and academic events. The argument is made for posters as an equal among scholarly presentation formats. The poster serves as a tremendous opportunity for collaboration between partners and a way to communicate important findings and advertise the presenters' work. For the advanced practice nurse who is a novice in presenting best practice or evidence from research trials, the poster format may be less intimidating while allowing the invaluable sharing of results. Four critical elements of professional poster development are deciding on a clear Purpose, targeting the right People, outlining key steps in the Process, and delivering a memorable Presentation. Using the "4 Ps" as cornerstones for the work of developing, preparing, and delivering the poster to an audience, the authors aim to help organize the entire process into these essential considerations. The poster, as a means of scholarly work, is a viable and essential activity, as interdisciplinary collaboration and sharing of best practice becomes the expectation for all professional development.

  6. For Elderly Needing Home Medical Care, Are Nurse Practitioners the Answer?

    MedlinePlus

    ... of Virginia Medical School's department of public health sciences. Nurse practitioners are nurses with advanced training. In some states, they can prescribe medicine and practice without direct supervision of a doctor the study authors noted. ...

  7. The effect of self-directed learning abilities of student nurses on success in Turkey.

    PubMed

    Avdal, Elif Ünsal

    2013-08-01

    SDL-self-directed learning is a learning method used increasingly in adult education. This study was carried out as an instructive effort to examine the effects of SDL on the success of students from nursing school. The sample of this study was composed of 220 students attending in Nursing School of Dokuz Eyül University during the fall semester of 2006. SDL scale including 40 questions was used to obtain the data. Kocaman et al. verified and validated the reliability of scale in Turkey. The data was evaluated by using Pearson correlation analysis. As a result of research, a positive meaningful average relation was found between the points of SDL and success of the students. (p<0.01, r: .60).

  8. A changing landscape for advance directives in dementia research.

    PubMed

    Pierce, Robin

    2010-02-01

    The number of persons afflicted by dementia has increased steadily. The need for research leading to diagnostic and therapeutic interventions is widely recognized. However, dementia patients eventually lose the capacity to consent to the very research that could lead to discoveries of effective interventions. Worldwide, surrogate decision-making remains the primary means of consent for this population. This significantly restricts the autonomy of competent patients who wish to prospectively consent to research and do not wish to relinquish this decision to a third party. Advance research directives (ARDs) have been proposed as a mechanism for prospective consent for persons who anticipate cognitive impairment, as in the case of prodromal or early stage dementia patients. Currently, few guidelines specifically address the use of ARDs despite calls for official recognition. This absence of official guidelines regarding ARDs renders this mechanism susceptible to misuse, under-use, or non-use in instances where it could be advantageous for individuals, their families/caregivers, and progress in dementia research and treatment. This paper explores the changing landscape of ARDs, identifying relevant scientific, social, and policy developments, and queries whether, under these circumstances, reticence to use, recognize, or regulate ARDs is justified. It addresses some of the persistent issues related to vulnerability, the role of surrogates, and scope of prospective consent, and concludes that ARDs can serve as an important mechanism of autonomy and empowerment, and that protections should be crafted such that the availability of this option is not limited to those who also appoint a surrogate.

  9. HIV Vaccine: Recent Advances, Current Roadblocks, and Future Directions

    PubMed Central

    Rubens, Muni; Ramamoorthy, Venkataraghavan; Saxena, Anshul; Shehadeh, Nancy; Appunni, Sandeep

    2015-01-01

    HIV/AIDS is a leading cause of mortality and morbidity worldwide. In spite of successful interventions and treatment protocols, an HIV vaccine would be the ultimate prevention and control strategy. Ever since identification of HIV/AIDS, there have been meticulous efforts for vaccine development. The specific aim of this paper is to review recent vaccine efficacy trials and associated advancements and discuss the current challenges and future directions. Recombinant DNA technologies greatly facilitated development of many viral products which were later incorporated into vectors for effective vaccines. Over the years, a number of scientific approaches have gained popularity and include the induction of neutralizing antibodies in late 1980s, induction of CD8 T cell in early 1990s, and combination approaches currently. Scientists have hypothesized that stimulation of right sequences of somatic hypermutations could induce broadly reactive neutralizing antibodies (bnAbs) capable of effective neutralization and viral elimination. Studies have shown that a number of host and viral factors affect these processes. Similarly, eliciting specific CD8 T cells immune responses through DNA vaccines hold future promises. In summary, future studies should focus on the continuous fight between host immune responses and ever-evasive viral factors for effective vaccines. PMID:26579546

  10. [Characteristics and aims of patient advance directive laws].

    PubMed

    Kletecka-Pulker, Maria

    2008-01-01

    The advanced directive law (PatVG), which regulates the conditions and effectiveness of living wills, has been in force since 1 June 2006. A living will is a declaration of will with which a patient refuses certain medical treatment for the case that he is no longer able to understand the situation, make ajudgement or to express himself. In contrast to the non-anticipatory rejection of treatment, the legislator demands, in the case of anticipatory rejection, the fulfilment of certain conditions. The law provides for two forms of living will 1. the non-binding living will and 2. the binding living will. In the case of a binding will, if the patient is no longer able to understand the situation or to make a judgement and/or is unable to express himself, the doctor has to respect the living will and under no circumstances is allowed to carry out the measures which the patient has refused. If one conditions for a binding living will is not fulfilled, the will is then non-binding. However, the greater the number of conditions which are fulfilled, the more likely it is that a doctor will consider it binding. In all cases, the binding living will serves as an aid for the doctor to indicate the will of the patient.

  11. Engaging Patients with Advance Directives using an Information Visualization Approach

    PubMed Central

    Woollen, Janet; Bakken, Suzanne

    2016-01-01

    Despite the benefits of advance directives (AD) to both patients and care providers, they are often not completed due to lack of patient awareness. The purpose of this paper is to advocate for creation and use of an innovative information visualization (infovisual) as a health communication tool aimed at improving AD dissemination and engagement. The infovisual would promote AD awareness by engaging patients to learn about their options and inspire contemplation and conversation regarding patients’ end-of-life (EOL) journey. An infovisual may be able to communicate insights that are often communicated in words, but are much more powerfully communicated by example. Furthermore, an infovisual could facilitate vivid understanding of options and inspire the beginning of often-difficult conversations between care providers, patients and loved ones. It may also save clinicians’ time, as care providers may be able to spend less time explaining details of EOL care options. Use of an infovisual could assist in ensuring a well-planned EOL. PMID:26273950

  12. Prevalence of Advance Directives Among Older Adults Admitted to Intensive Care Units and Requiring Mechanical Ventilation.

    PubMed

    Gamertsfelder, Elise M; Seaman, Jennifer Burgher; Tate, Judith; Buddadhumaruk, Praewpannarai; Happ, Mary Beth

    2016-04-01

    Because older adults are at high risk for hospitalization and potential decisional incapacity, advance directives are important components of pre-hospital advanced care planning, as they document individual preferences for future medical care. The prevalence of pre-hospital advance directive completion in 450 critically ill older adults requiring mechanical ventilation from two Mid-Atlantic hospitals is described, and demographic and clinical predictors of pre-hospital advance directive completion are explored. The overall advance directive completion rate was 42.4%, with those in older age groups (75 to 84 years and 85 and older) having approximately two times the odds of completion. No significant differences in the likelihood of advance directive completion were noted by sex, race, or admitting diagnosis. The relatively low prevalence of advance directive completion among older adults with critical illness and high mortality rate (24%) suggest a need for greater awareness and education.

  13. Processing of alnico permanent magnets by advanced directional solidification methods

    SciTech Connect

    Zou, Min; Johnson, Francis; Zhang, Wanming; Zhao, Qi; Rutkowski, Stephen F.; Zhou, Lin; Kramer, Matthew J.

    2016-07-05

    Advanced directional solidification methods have been used to produce large (>15 cm length) castings of Alnico permanent magnets with highly oriented columnar microstructures. In combination with subsequent thermomagnetic and draw thermal treatment, this method was used to enable the high coercivity, high-Titanium Alnico composition of 39% Co, 29.5% Fe, 14% Ni, 7.5% Ti, 7% Al, 3% Cu (wt%) to have an intrinsic coercivity (Hci) of 2.0 kOe, a remanence (Br) of 10.2 kG, and an energy product (BH)max of 10.9 MGOe. These properties compare favorably to typical properties for the commercial Alnico 9. Directional solidification of higher Ti compositions yielded anisotropic columnar grained microstructures if high heat extraction rates through the mold surface of at least 200 kW/m2 were attained. This was achieved through the use of a thin walled (5 mm thick) high thermal conductivity SiC shell mold extracted from a molten Sn bath at a withdrawal rate of at least 200 mm/h. However, higher Ti compositions did not result in further increases in magnet performance. Images of the microstructures collected by scanning electron microscopy (SEM) reveal a majority α phase with inclusions of secondary αγ phase. Transmission electron microscopy (TEM) reveals that the α phase has a spinodally decomposed microstructure of FeCo-rich needles in a NiAl-rich matrix. In the 7.5% Ti composition the diameter distribution of the FeCo needles was bimodal with the majority having diameters of approximately 50 nm with a small fraction having diameters of approximately 10 nm. The needles formed a mosaic pattern and were elongated along one <001> crystal direction (parallel to the field used during magnetic annealing). Cu precipitates were observed between the needles. Regions of abnormal spinodal morphology appeared to correlate with secondary phase precipitates. The presence of these abnormalities did not prevent the material from displaying

  14. Processing of alnico permanent magnets by advanced directional solidification methods

    DOE PAGES

    Zou, Min; Johnson, Francis; Zhang, Wanming; ...

    2016-07-05

    Advanced directional solidification methods have been used to produce large (>15 cm length) castings of Alnico permanent magnets with highly oriented columnar microstructures. In combination with subsequent thermomagnetic and draw thermal treatment, this method was used to enable the high coercivity, high-Titanium Alnico composition of 39% Co, 29.5% Fe, 14% Ni, 7.5% Ti, 7% Al, 3% Cu (wt%) to have an intrinsic coercivity (Hci) of 2.0 kOe, a remanence (Br) of 10.2 kG, and an energy product (BH)max of 10.9 MGOe. These properties compare favorably to typical properties for the commercial Alnico 9. Directional solidification of higher Ti compositions yieldedmore » anisotropic columnar grained microstructures if high heat extraction rates through the mold surface of at least 200 kW/m2 were attained. This was achieved through the use of a thin walled (5 mm thick) high thermal conductivity SiC shell mold extracted from a molten Sn bath at a withdrawal rate of at least 200 mm/h. However, higher Ti compositions did not result in further increases in magnet performance. Images of the microstructures collected by scanning electron microscopy (SEM) reveal a majority α phase with inclusions of secondary αγ phase. Transmission electron microscopy (TEM) reveals that the α phase has a spinodally decomposed microstructure of FeCo-rich needles in a NiAl-rich matrix. In the 7.5% Ti composition the diameter distribution of the FeCo needles was bimodal with the majority having diameters of approximately 50 nm with a small fraction having diameters of approximately 10 nm. The needles formed a mosaic pattern and were elongated along one <001> crystal direction (parallel to the field used during magnetic annealing). Cu precipitates were observed between the needles. Regions of abnormal spinodal morphology appeared to correlate with secondary phase precipitates. The presence of these abnormalities did not prevent the material from displaying superior magnetic properties in the 7.5% Ti

  15. Processing of alnico permanent magnets by advanced directional solidification methods

    NASA Astrophysics Data System (ADS)

    Zou, Min; Johnson, Francis; Zhang, Wanming; Zhao, Qi; Rutkowski, Stephen F.; Zhou, Lin; Kramer, Matthew J.

    2016-12-01

    Advanced directional solidification methods have been used to produce large (>15 cm length) castings of Alnico permanent magnets with highly oriented columnar microstructures. In combination with subsequent thermomagnetic and draw thermal treatment, this method was used to enable the high coercivity, high-Titanium Alnico composition of 39% Co, 29.5% Fe, 14% Ni, 7.5% Ti, 7% Al, 3% Cu (wt%) to have an intrinsic coercivity (Hci) of 2.0 kOe, a remanence (Br) of 10.2 kG, and an energy product (BH)max of 10.9 MGOe. These properties compare favorably to typical properties for the commercial Alnico 9. Directional solidification of higher Ti compositions yielded anisotropic columnar grained microstructures if high heat extraction rates through the mold surface of at least 200 kW/m2 were attained. This was achieved through the use of a thin walled (5 mm thick) high thermal conductivity SiC shell mold extracted from a molten Sn bath at a withdrawal rate of at least 200 mm/h. However, higher Ti compositions did not result in further increases in magnet performance. Images of the microstructures collected by scanning electron microscopy (SEM) reveal a majority α phase with inclusions of secondary αγ phase. Transmission electron microscopy (TEM) reveals that the α phase has a spinodally decomposed microstructure of FeCo-rich needles in a NiAl-rich matrix. In the 7.5% Ti composition the diameter distribution of the FeCo needles was bimodal with the majority having diameters of approximately 50 nm with a small fraction having diameters of approximately 10 nm. The needles formed a mosaic pattern and were elongated along one <001> crystal direction (parallel to the field used during magnetic annealing). Cu precipitates were observed between the needles. Regions of abnormal spinodal morphology appeared to correlate with secondary phase precipitates. The presence of these abnormalities did not prevent the material from displaying superior magnetic properties in the 7.5% Ti

  16. New Directions for NASA's Advanced Life Support Program

    NASA Technical Reports Server (NTRS)

    Barta, Daniel J.

    2006-01-01

    Exploration Life Support (ELS) Project, under the Exploration Technology Development Program, has recently been initiated to perform directed life support technology development in support of Constellation and the Crew Exploration Vehicle (CEV). ELS) has replaced ALS, with several major differences. Thermal Control Systems have been separated into a new stand alone project (Thermal Systems for Exploration Missions). Tasks in Advanced Food Technology have been relocated to the Human Research Program. Tasks in a new discipline area, Habitation Engineering, have been added. Research and technology development for capabilities required for longer duration stays on the Moon and Mars, including bioregenerative system, have been deferred.

  17. UTILITY OF MECHANISTIC MODELS FOR DIRECTING ADVANCED SEPARATIONS RESEARCH & DEVELOPMENT ACTIVITIES: Electrochemically Modulated Separation Example

    SciTech Connect

    Schwantes, Jon M.

    2009-06-01

    The objective for this work was to demonstrate the utility of mechanistic computer models designed to simulate actinide behavior for use in efficiently and effectively directing advanced laboratory R&D activities associated with developing advanced separations methods.

  18. 42 CFR 422.128 - Information on advance directives.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits and Beneficiary Protections § 422... clear and precise statement of limitation if the MA organization cannot implement an advance...

  19. 42 CFR 422.128 - Information on advance directives.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits and Beneficiary Protections § 422... clear and precise statement of limitation if the MA organization cannot implement an advance...

  20. Eastern Association for the Surgery of Trauma & Society of Trauma Nurses Advanced Practitioner Position Paper: Optimizing the integration of advanced practitioners in trauma and critical care.

    PubMed

    Messing, Jonathan; Garces-King, Jasmine; Taylor, Dennis; Van Horn, Jonathan; Sarani, Babak; Christmas, A Britton

    2017-03-21

    Nurse Practitioners and Physician Assistants, collectively known as advanced practitioners (APs), enhance the provision of care for the acutely injured patient. Despite their prevalence, institutions employ, train, and utilize these providers with significant variability. The Eastern Association for the Surgery of Trauma (EAST), the Society of Trauma Nurses (STN), and the American Association of Surgical Physicians Assistants (AASPA) acknowledge the value of APs and support their utilization in the management of injured and critically ill patients. This position paper offers insight into the history of, scope of practice for, and opportunities for optimal utilization of APs in trauma, critical care, and acute care surgery services.

  1. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

    PubMed Central

    Bryant-Lukosius, Denise; Valaitis, Ruta; Martin-Misener, Ruth; Donald, Faith; Peña, Laura Morán; Brousseau, Linda

    2017-01-01

    ABSTRACT Objective: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries. PMID:28146177

  2. Using saliva to measure endogenous cortisol in nursing home residents with advanced dementia.

    PubMed

    Woods, Diana Lynn; Kovach, Christine R; Raff, Hershel; Joosse, Laura; Basmadjian, Alicia; Hegadoren, Kathleen M

    2008-06-01

    Two research teams determined the feasibility of saliva collection for cortisol measurement in nursing home residents with advanced dementia. Study aims were to: (a) determine if sufficient saliva could be obtained for assay and (b) examine whether cortisol values exhibited range and variability for meaningful interpretation. Useable samples were consistent across sites, suggesting that saliva collection for cortisol assay is a viable method in this setting. Cortisol values showed range and variability. More than half of the residents showed the normal adult pattern of high morning levels decreasing throughout the day. A third of the participants demonstrated an increase in the evening cortisol levels, while the remaining profiles were flat, suggesting hypothalamic-pituitary-adrenal (HPA) dysregulation in this population.

  3. Opioid therapy for chronic low back pain: prescribing considerations for advanced practice registered nurses.

    PubMed

    Lall, Maureen Patricia

    2014-12-01

    Chronic low back pain is a common, disabling, and costly condition, and advanced practice registered nurses (APRNs) must carefully evaluate patients before considering long-term opioid therapy as a management strategy. APRNs should refer patients suspected of having a serious condition, or identifiable etiology, for specialist evaluation, as many patients improve with physical therapy, interventional pain management procedures, or surgical intervention. For patients unresponsive to nonopioid treatment, APRNs with an understanding of opioids, and the experience to assess and manage the risks of opioid misuse, abuse, and diversion, may consider long-term opioid therapy as part of a multimodal management plan. Such prescribing necessitates careful patient selection; informed consent; prudent opioid dosing and titration; and monitoring for response to treatment, adverse effects, and aberrant drug-taking behavior. Treatment and regulatory guidelines can assist APRNs in providing safe and effective care to patients with chronic low back pain.

  4. End-of-Life Decision Making for Nursing Home Residents with Dementia: A Survey of Nursing Home Social Services Staff

    ERIC Educational Resources Information Center

    Lacey, Debra

    2006-01-01

    The purpose of this survey was to describe nursing home social services staff roles and perceptions related to end-of-life medical decision making for nursing home residents in endstage dementia. Using a self-designed questionnaire, 138 nursing home social services staff from across New York State answered questions about advance directives,…

  5. How advance directives affect hospital resource use. Systematic review of the literature.

    PubMed Central

    Taylor, J. S.; Heyland, D. K.; Taylor, S. J.

    1999-01-01

    OBJECTIVE: To assess whether advance directives influence resource use by hospitalized patients. DATA SOURCES: A systematic search of computerized medical databases, reference lists from relevant articles, and personal files was conducted to identify studies examining the association between advance directives and resource use. STUDY SELECTION: Primary studies assessing the effect of advance directives on hospital resource use were selected if they had a clear quantitative measure of hospital resource use, hospitalized patients as a study population, a control group for comparison, and a description of the advance directive being studied. Data on the following topics were abstracted from studies meeting inclusion criteria: study methods and design, resource use, source of financial data, description of advance directive, population size and composition, length of assessment. SYNTHESIS: Six studies met inclusion criteria. Three retrospective studies showed significant reductions in resource use associated with documentation of advance directives while three prospective studies (two randomized, one not randomized) showed no association between advance directives and reduced resource use. Studies were limited to narrowly defined patient populations in US tertiary care hospitals. CONCLUSIONS: Little evidence supports the hypothesis that advance directives reduce resource use by hospitalized patients. Some retrospective studies have shown savings, but their conclusions are weakened by shortcomings in study design. Prospective trials, which have better experimental methods, have demonstrated no evidence of cost savings with the use of advance directives. PMID:10540700

  6. [Development of an advanced education program for community medicine by Nagasaki pharmacy and nursing science union consortium].

    PubMed

    Teshima, Mugen; Nakashima, Mikiro; Hatakeyama, Susumi

    2012-01-01

    The Nagasaki University School of Pharmaceutical Sciences has conducted a project concerning "development of an advanced education program for community medicine" for its students in collaboration with the University's School of Nursing Sciences, the University of Nagasaki School of Nursing Sciences, and the Nagasaki International University School of Pharmaceutical Sciences. The project was named "formation of a strategic base for the integrated education of pharmacy and nursing science specially focused on home-healthcare and welfare", that has been adopted at "Strategic University Cooperative Support Program for Improving Graduate" by the Ministry of Education, Culture, Sports, Science and Technology, Japan from the 2009 academic year to the 2011 academic year. Our project is a novel education program about team medical care in collaboration with pharmacist and nurse. In order to perform this program smoothly, we established "Nagasaki pharmacy and nursing science union consortium (Nagasaki University, The University of Nagasaki, Nagasaki International University, Nagasaki Pharmaceutical Association, Nagasaki Society of Hospital Pharmacists, Nagasaki Nursing Association, Nagasaki Medical Association, Nagasaki Prefectural Government)". In this symposium, we introduce contents about university education program and life learning program of the project.

  7. Service user and clinical perspectives of psychiatric advance directives in New Zealand.

    PubMed

    Thom, Katey; O'Brien, Anthony John; Tellez, Juan Jose

    2015-12-01

    Advance care planning is becoming an increasingly important feature of health service provision. Although the New Zealand Mental Health Commission has advocated strongly for the provision of advance directives in mental health services, little is known about clinician or service user views on advance directives. The aim of the study was to survey the perspectives of service users and clinicians on the use of psychiatric advance directives. The study used an anonymous online survey to collect data from 110 mental health service users and 175 clinicians. Survey items included existing knowledge, preferred content and potential benefits of advance directives. Descriptive statistics and intergroup comparisons were conducted. Over 90% of service users and clinicians agreed that they support advance directives in mental health. There were similarities in the preferred content of an advance directive across the two groups, particularly regarding the notification of support persons, cultural support and preferred methods of de-escalation. Significant differences in opinion were found regarding the use of coercive measures and the ability of mental health legislation to override advance directives. The results indicate strong support for the use of advance directives within New Zealand mental health services, as well as for further research in the area.

  8. Mini Review of Integrated Care and Implications for Advanced Practice Nurse Role

    PubMed Central

    McIntosh, Diana; Startsman, Laura F.; Perraud, Suzanne

    2016-01-01

    Literature related to primary care and behavioral health integration initiatives is becoming abundant. The United States’ 2010 Patient Protection and Affordable Care Act included provisions encouraging increased collaboration of care for individuals with behavioral and physical health service needs in the public sector. There is relatively little known of Advanced Practice Registered Nurses’ (APRNs) roles with integrating primary and behavioral healthcare. The goal of this review article is to: (a) define integration of physical and behavioral healthcare and potential models; (b) answer the question as to what are effective evidence based models/strategies for integrating behavioral health and primary care; (c) explore the future role and innovations of APRNs in the integration of physical and behavioral healthcare. Results: The evidence- based literature is limited to three systematic reviews and six randomized controlled trials. It was difficult to generalize the data and the effective integration strategies varied from such interventions as care management to use of sertraline to depression management and to access. There were, though, implications for the integrated care advanced practice nurse to have roles inclusive of competencies, leadership, engagement, collaboration and advocacy. PMID:27347258

  9. Enhancing presentation skills for the advanced practice nurse: strategies for success.

    PubMed

    Vollman, Kathleen M

    2005-01-01

    Professional speaking is a component of the professional practice role of the advanced practice nurse (APN). The skills to communicate effectively to one person or an audience of 100 provide the APN with the essential tools for implementing change, collaborating effectively, presenting information at professional meetings, or communicating the impact of clinical outcomes in the boardroom. Public speaking skills, a professional image, and improved communication can facilitate advancement along any career ladder. The greater your fear, the more self-confidence you will gain by stepping up to a challenge and conquering it. This article describes strategies for organizing and presenting your message in a clear and concise format. Techniques to manage the anxiety produced when attempting to articulate your thoughts is essential for effective communication. Skills for enhancing the delivery of your message through effective body language, professional image, voice modulation, and use of audiovisual aids are addressed. Creative techniques for fielding questions are key in promoting a dynamic closure and provide consistent reinforcement of the key message content.

  10. The future of nursing: domestic agenda, global implications.

    PubMed

    Shaffer, Franklin A; Davis, Catherine R; To Dutka, Julia; Richardson, Donna R

    2014-10-01

    The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, challenges the nursing profession to take a key role in redesigning the health care system. Intended to shape the future of nursing in the United States, the IOM report has implications for nursing worldwide. While individual states and nursing organizations are developing initiatives to implement the IOM recommendations in the United States, there must be a concomitant effort to examine the ripple effect on global health and the nursing community. This article addresses four IOM recommendations that are directly relevant to internationally educated nurses who practice across borders: nurse residency programs, lifelong learning, leading change to advance health, and interprofessional health care workforce data. The article discusses the IOM recommendations through a global perspective and offers policy implications for legislators, health care organizations and nurse educators, regulators and administrators.

  11. Variations in Consumer Self-Determination within US Psychiatric Advance Directives

    ERIC Educational Resources Information Center

    Zeman, Laura Dreuth; Swanke, Jayme

    2008-01-01

    Advance directives are legal documents that formalize consumer psychiatric care preferences. This article examines the statutes and goals of US psychiatric advance directives within the framework of consumer self-determination, a priority in national mental health reform. It seeks to distinguish between state models based on the degree that…

  12. Effect of Health Literacy on the Utilization of Advance Directives Based on the Health Belief Model

    ERIC Educational Resources Information Center

    Henkelman, Wallace J.

    2010-01-01

    Research has demonstrated that only a small proportion of individuals in the United States complete advance directives as part of their planning for end-of-life care. This study sought to determine if health literacy is a significant factor in advance directive completion as has been posited by previous researchers. Analysis of the data collected…

  13. Psychiatric epidemiology: selected recent advances and future directions.

    PubMed Central

    Kessler, R. C.

    2000-01-01

    Reviewed in this article are selected recent advances and future challenges for psychiatric epidemiology. Major advances in descriptive psychiatric epidemiology in recent years include the development of reliable and valid fully structured diagnostic interviews, the implementation of parallel cross-national surveys of the prevalences and correlates of mental disorders, and the initiation of research in clinical epidemiology. Remaining challenges include the refinement of diagnostic categories and criteria, recognition and evaluation of systematic underreporting bias in surveys of mental disorders, creation and use of accurate assessment tools for studying disorders of children, adolescents, the elderly, and people in less developed countries, and setting up systems to carry out small area estimations for needs assessment and programme planning. Advances in analytical and experimental epidemiology have been more modest. A major challenge is for psychiatric epidemiologists to increase the relevance of their analytical research to their colleagues in preventative psychiatry as well as to social policy analysts. Another challenge is to develop interventions aimed at increasing the proportion of people with mental disorders who receive treatment. Despite encouraging advances, much work still needs to be conducted before psychiatric epidemiology can realize its potential to improve the mental health of populations. PMID:10885165

  14. Directed Biosynthesis of Oriented Crystalline Cellulose for Advanced Composite Fibers

    DTIC Science & Technology

    2012-05-03

    Cellulose for Advanced Composite Fibers 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Hugh...properties will allow the synthesis of composites possessing improved strength and functionality will be investigated. The bacterial cellulose fibers will

  15. Overview of recent direct wafer bonding advances and applications

    NASA Astrophysics Data System (ADS)

    Moriceau, H.; Rieutord, F.; Fournel, F.; Le Tiec, Y.; Di Cioccio, L.; Morales, C.; Charvet, A. M.; Deguet, C.

    2010-12-01

    Direct wafer bonding processes are being increasingly used to achieve innovative stacking structures. Many of them have already been implemented in industrial applications. This article looks at direct bonding mechanisms, processes developed recently and trends. Homogeneous and heterogeneous bonded structures have been successfully achieved with various materials. Active, insulating or conductive materials have been widely investigated. This article gives an overview of Si and SiO2 direct wafer bonding processes and mechanisms, silicon-on-insulator type bonding, diverse material stacking and the transfer of devices. Direct bonding clearly enables the emergence and development of new applications, such as for microelectronics, microtechnologies, sensors, MEMs, optical devices, biotechnologies and 3D integration.

  16. Advance directives outside the USA: are they the best solution everywhere?

    PubMed

    Sanchez-Gonzalez, M A

    1997-09-01

    This article evaluates the potential role of advance directives outside of their original North American context. In order to do this, the article first analyses the historical process which has promoted advance directives in recent years. Next, it brings to light certain presuppositions which have given them force: atomistic individualism, contractualism, consumerism and entrepreneurialism, pluralism, proceduralism, and "American moralism." The article next studies certain European cultural peculiarities which could affect advance directives: the importance of virtue versus rights, stoicism versus consumerist utilitarianism, rationalism verus empiricism, statism versus citizens' initiative, and justice versus autonomy. The article concludes by recognising that autonomy has a transcultural value, although it must be balanced with other principles. Advance Directives can have a function in certain cases. But it does not seem adequate to delegate to advance directives more and more medical decisions, and to make them more binding everyday. It is indispensable to develop other decision-making criteria.

  17. Partnership for the Advancement of Information Literacy in a Nursing Program

    ERIC Educational Resources Information Center

    Beck, Sheila; Blake-Campbell, Barbara; McKay, Devin

    2012-01-01

    Nursing educators know that healthcare stakeholders expect nursing graduates to be able to manage information. Consequently, many nursing education programs are exploring ways of integrating information literacy across the curriculum not only to bolster evidence-based practice, but also to enhance professional development and encourage lifelong…

  18. Advanced Practice Nursing: Is the Physician's Assistant an Accident of History or a Failure to Act?

    ERIC Educational Resources Information Center

    Christman, Luther

    1998-01-01

    The responses of some nursing organizations regarding the establishment of collaborative relationships in the nursing profession may be responsible for the development of the physician assistant profession. The nursing profession should examine these responses while planning strategies to cope with the current chaos in health care. (JOW)

  19. Feminist and queer phenomenology: a framework for perinatal nursing practice, research, and education for advancing lesbian health.

    PubMed

    Goldberg, Lisa; Ryan, Annette; Sawchyn, Jody

    2009-06-01

    A queer phenomenology would involve an orientation toward queer, a way to inhabit the world that gives "support" to those whose lives and loves make them appear oblique, strange, and out of place. (Ahmed, 2006) The climate of the health care system is a reflection of society, which often hesitates to support individuals who choose paths other than those, that are heteronormatively constructed. Consequences of such limited directedness include fear, misunderstanding, avoidance, and discrimination on the part of nurses toward individuals involved in same-sex partnerships (Goldberg, 2005/2006). A feminist and queer phenomenological framework offers an approach for perinatal nurses to advance lesbian health and, in particular, lesbian couples' experiences of birthing, in the context of nursing practice, research, and education.

  20. The outcome of interprofessional education: Integrating communication studies into a standardized patient experience for advanced practice nursing students.

    PubMed

    Defenbaugh, Nicole; Chikotas, Noreen E

    2016-01-01

    The purpose of this qualitative study was to examine the impact of standardized patient experiences (SPE) in the education of the Advanced Practice Nurse (APN). The education of the APN requires educators to make every attempt to promote competency in the areas of communication and clinical-decision making. SPE programs have been found to improve the interpersonal, problem solving, and critical thinking skills of nursing students. For this research twenty-nine APN students participated in SPEs over the course of two semesters. Fifteen student volunteers of those 29 participants were then interviewed three months after the experience. Results revealed that having an expert in the field of communication studies increased awareness of communication skills and how to improve nurse-patient encounters in the clinical setting. The interprofessional collaboration during the SPEs assisted in facilitating the application of learned communication skills into patient-centered care of the APN student.

  1. Changing the way that I am: students experience of educational preparation for advanced nursing roles in the community.

    PubMed

    Illingworth, Andrea; Aranda, Kay F; De Goeas, Sharon M; Lindley, Penny J

    2013-09-01

    The redesign of the healthcare workforce in the United Kingdom (UK) has resulted in the rapid introduction of more 'advanced' community nursing roles. This presents varying challenges for universities seeking to prepare practitioners for these roles. This paper reports on a qualitative study conducted at one university in England which sought to explore the educational experiences of students preparing for and engaging in advanced nursing roles. Data was collected through focus groups and semi-structured interviews. This study found that educational preparation for advanced nursing roles in the community is varied and complex and involved a number of claims, concerns and issues, captured in three themes: 1. Re-inventing roles; 2. Re-creating selves; and 3. Re-engaging with learning. The findings reveal how those in advanced roles work across occupational boundaries and manage conflicts, using differentiated and complex sources and forms of knowledge and skills. Learning occurs in non-linear ways and is a good example of expansive or sideways learning. There is a need for further research on the type of curriculum and methods to best support students preparing for these roles and further study on the impact on patient experience and outcomes.

  2. Advanced Gasoline Turbocharged Direction Injection (GTDI) Engine Development

    SciTech Connect

    Wagner, Terrance

    2015-12-31

    This program was undertaken in response to US Department of Energy Solicitation DE-FOA-0000079, resulting in a cooperative agreement with Ford and MTU to demonstrate improvement of fuel efficiency in a vehicle equipped with an advanced GTDI engine. Ford Motor Company has invested significantly in GTDI engine technology as a cost effective, high volume, fuel economy solution, marketed globally as EcoBoost technology. Ford envisions additional fuel economy improvement in the medium and long term by further advancing EcoBoost technology. The approach for the project was to engineer a comprehensive suite of gasoline engine systems technologies to achieve the project objectives, and to progressively demonstrate the objectives via concept analysis / computer modeling, single-cylinder and multi-cylinder engine testing on engine dynamometer, and vehicle level testing on chassis rolls.

  3. Breaking New Ground: An Exploratory Study of the Role and Education of the Advanced Neonatal Nurse Practitioner. Researching Professional Education. Research Reports Series Number 4.

    ERIC Educational Resources Information Center

    Redshaw, M. E.; Harris, A.

    A British research study documented and defined the level of functioning of advanced neonatal nurse practitioners (ANNPs) in comparison with qualified nurses and junior pediatric medical staff working in the same neonatal units. Subjects were ANNPs, ANNP students, and clinician mentors in 10 units. Data were collected through interviews,…

  4. Too Soon to Give Up? Re-examining the Value of Advance Directives

    PubMed Central

    Levi, Benjamin H.; Green, Michael J.

    2013-01-01

    In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future, translates an individual’s values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by 1) educating users about advance care planning; 2) helping individuals identify, clarify, and prioritize factors that influence their decision-making about future medical conditions; 3) explaining common end-of-life medical conditions and life-sustaining treatment; 4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and 5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and healthcare providers in discussions about advance care planning. PMID:20379910

  5. Too soon to give up: re-examining the value of advance directives.

    PubMed

    Levi, Benjamin H; Green, Michael J

    2010-04-01

    In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future, translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping individuals identify, clarify, and prioritize factors that influence their decision-making about future medical conditions; (3) explaining common end-of-life medical conditions and life-sustaining treatment; (4) helping users articulate a coherent set of wishes with regard to advance care planning-in the form of an advance directive readily interpretable by physicians; and (5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and health care providers in discussions about advance care planning.

  6. The law and practice associated with advance directives in Canada and Australia: similarities, differences and debates.

    PubMed

    Brown, Margaret

    2003-08-01

    This article is a summary of research that investigated the Canadian and Australian legislative framework associated with advance directives in health care. The research focused on the context in which older people are encouraged to use advance directives. These are directions about refusal of medical treatment given in advance of incompetence. An advance directive may be given in a written document (living will) expressing one's wishes, by appointing another person (proxy) to make the decisions, or as a combination of the two. A lack of consistency and clarity about the terminology was found in both countries. This could be a barrier for older people to express their wishes in advance. Several confusing issues were also identified with the legislation related to advance directives. There appears to be a move towards appointing a substitute decision-maker, but with significant differences across the Australian States and in Canadian Provinces. The "conversation" about future decisions emerged as an important theme, together with an emphasis on the process of "advance care planning" replacing the focus on advance directive forms.

  7. Caring for older cancer patients: practical decision-making guidelines with a focus on advance directives.

    PubMed

    Sachs, G A

    1992-02-01

    There are no simple solutions to difficult ethical problems. Advance directives, however, offer a way to help prevent ethical dilemmas from occurring in the care of older cancer patients. Studies show that there is overwhelming support from both older patients and physicians for advance treatment planning through the use of living wills, durable powers of attorney for health care, and less formal means. Despite this support, few physicians and patients discuss advance directives. This paper discusses potential barriers to this dialogue and suggests specific ways to incorporate advance directive into routine cancer care of older patients. The Patient Self-Determination Act of 1990 represents additional pressure from society on the medical profession to carry out advance directive discussions.

  8. Consultancy pay for nurses.

    PubMed

    1998-01-01

    Nurses working for NHS Direct could be paid at medical consultant level based on equal pay for equal work initiatives, according to Rob Crouch, Deputy Director and Research Fellow (A&E), Centre for the Advancement of Clinical Practice, University of Surrey.

  9. A streamlined clinical advancement program improves RN participation and retention.

    PubMed

    Allen, Susan R; Fiorini, Pamela; Dickey, Michelle

    2010-01-01

    Retaining expert nurses in direct care is essential to quality patient outcomes. The goal of the clinical advancement program at Cincinnati Children's Hospital Medical Center has always been to recruit, retain, recognize, and reward nurses in direct care. A program revision in 2002 markedly increased nursing promotions and a higher retention rate for program participants versus their peers' retention rate of 88%. Nearly 40% of the hospital's nurses now participate in the program.

  10. International Transplant Nurses Society

    MedlinePlus

    ... and professional practice in nursing." Demonstration of professional development support and clinical advancement programs are hallmarks of a professional nursing practice environment and critical components of Nursing Magnet status. The ...

  11. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    PubMed

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2014-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

  12. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    PubMed

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2011-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

  13. Right person, right skills, right job: the contribution of objective structured clinical examinations in advancing staff nurse experts.

    PubMed

    Mitchell, Marion; Strube, Petra; Vaux, Amanda; West, Nicky; Auditore, Anthony

    2013-10-01

    Recruitment processes need to discriminate among candidates to ensure that the right person with the right skills is selected for advancement opportunities. An innovative recruitment process using an objective structured clinical examination grounded in best practice guidelines resulted in improved recruitment practices for senior nursing clinical expert roles. Candidates' skills, knowledge, and attitudes in the areas of patient focus, clinical expertise, teamwork, and leadership were assessed using a clinical simulation. Candidates achieving advancement were assessed at 6 months to validate the efficacy of the process.

  14. Advanced direct liquefaction concepts for PETC generic units

    SciTech Connect

    Not Available

    1992-04-01

    In the Advance Coal Liquefaction Concept Proposal (ACLCP) carbon monoxide (CO) and water have been proposed as the primary reagents in the pretreatment process. The main objective of this project is to develop a methodology for pretreating coal under mild conditions based on a combination of existing processes which have shown great promise in liquefaction, extraction and pyrolysis studies. The aim of this pretreatment process is to partially depolymerise the coal, eliminate oxygen and diminish the propensity for retograde reactions during subsequent liquefaction. The desirable outcome of the CO pretreatment step should be: (1) enhanced liquefaction activity and/or selectivity toward products of higher quality due to chemical modification of the coal structure; (2) cleaner downstream products; (3) overall improvement in operability and process economics.

  15. Cardiac gene therapy: Recent advances and future directions.

    PubMed

    Mason, Daniel; Chen, Yu-Zhe; Krishnan, Harini Venkata; Sant, Shilpa

    2015-10-10

    Gene therapy has the potential to serve as an adaptable platform technology for treating various diseases. Cardiovascular disease is a major cause of mortality in the developed world and genetic modification is steadily becoming a more plausible method to repair and regenerate heart tissue. Recently, new gene targets to treat cardiovascular disease have been identified and developed into therapies that have shown promise in animal models. Some of these therapies have advanced to clinical testing. Despite these recent successes, several barriers must be overcome for gene therapy to become a widely used treatment of cardiovascular diseases. In this review, we evaluate specific genetic targets that can be exploited to treat cardiovascular diseases, list the important delivery barriers for the gene carriers, assess the most promising methods of delivering the genetic information, and discuss the current status of clinical trials involving gene therapies targeted to the heart.

  16. Immunotherapy in melanoma: Recent advances and future directions.

    PubMed

    Franklin, C; Livingstone, E; Roesch, A; Schilling, B; Schadendorf, D

    2017-03-01

    Malignant melanoma contributes the majority of skin cancer related deaths and shows an increasing incidence in the past years. Despite all efforts of early diagnosis, metastatic melanoma still has a poor prognosis and remains a challenge for treating physicians. In recent years, improved knowledge of the pathophysiology and a better understanding of the role of the immune system in tumour control have led to the development and approval of several immunotherapies. Monoclonal antibodies against different immune checkpoints have been revolutionizing the treatment of metastatic and unresectable melanoma. Ipilimumab, a monoclonal antibody against the cytotoxic T-lymphocyte antigen 4 (CTLA-4) as well as nivolumab and pembrolizumab which target the programmed cell death protein 1 (PD-1) have been shown to prolong overall survival in patients with advanced melanoma. The latter substances seem to have an increased response rate and more tolerable safety profile compared to ipilimumab. The combination of a CTLA-4 and a PD-1 inhibitor seems to be superior to the monotherapies, especially in patients with PD-L1 negative tumours. Checkpoint inhibitors are currently being tested in the adjuvant setting with initial data for ipilimumab suggesting efficacy in this context. Talimogene laherparepvec (TVEC) is the first oncolytic virus approved in the therapy of metastatic melanoma offering a treatment option especially for patients with limited disease. In this review, data on these recently developed and approved immunotherapies are presented. However, further studies are necessary to determine the optimal duration, sequencing and combinations of immunotherapies to further improve the outcome of patients with advanced melanoma.

  17. Advancing HIV Nursing Practice: The Doctor of Nursing Practice HIV Specialty at Rutgers, the State University of New Jersey.

    PubMed

    Willard, Suzanne; Nelson, John; Reyes, Darcel; Linn, Annē

    2016-01-01

    The move to integrate HIV treatment and care into primary care is a major obstacle for the current U.S. health care workforce. Many HIV specialty providers will soon retire, while few primary care clinicians have been adequately trained in the diagnosis, care, and treatment of people living with HIV. The Health Resources and Services Administration (HRSA) has supported the development of a Doctor of Nursing Practice (DNP) program with an HIV specialty at Rutgers, the State University of New Jersey, to assure successful transition to an HIV primary care workforce. The Rutgers School of Nursing has been at the forefront of the DNP education movement and is among the first to develop an HIV-focused DNP program. Thirty-seven students have enrolled in the 3-year program, and two have graduated from the first cohort. Here we discuss the planning, implementation, successes, and recommendations of the new program.

  18. Through the lens of Merleau-Ponty: advancing the phenomenological approach to nursing research.

    PubMed

    Thomas, Sandra P

    2005-01-01

    Phenomenology has proved to be a popular methodology for nursing research. I argue, however, that phenomenological nursing research could be strengthened by greater attention to its philosophical underpinnings. Many research reports devote more page space to procedure than to the philosophy that purportedly guided it. The philosophy of Maurice Merleau-Ponty is an excellent fit for nursing, although his work has received less attention than that of Husserl and Heidegger. In this paper, I examine the life and thought of Merleau-Ponty, with emphasis on concepts, such as perception, intentionality and embodiment, which have particular relevance to the discipline of nursing.

  19. Advanced Low Conductivity Thermal Barrier Coatings: Performance and Future Directions

    NASA Technical Reports Server (NTRS)

    Zhu, Dongming; Miller, Robert A.

    2008-01-01

    Thermal barrier coatings will be more aggressively designed to protect gas turbine engine hot-section components in order to meet future engine higher fuel efficiency and lower emission goals. In this presentation, thermal barrier coating development considerations and performance will be emphasized. Advanced thermal barrier coatings have been developed using a multi-component defect clustering approach, and shown to have improved thermal stability and lower conductivity. The coating systems have been demonstrated for high temperature combustor applications. For thermal barrier coatings designed for turbine airfoil applications, further improved erosion and impact resistance are crucial for engine performance and durability. Erosion resistant thermal barrier coatings are being developed, with a current emphasis on the toughness improvements using a combined rare earth- and transition metal-oxide doping approach. The performance of the toughened thermal barrier coatings has been evaluated in burner rig and laser heat-flux rig simulated engine erosion and thermal gradient environments. The results have shown that the coating composition optimizations can effectively improve the erosion and impact resistance of the coating systems, while maintaining low thermal conductivity and cyclic durability. The erosion, impact and high heat-flux damage mechanisms of the thermal barrier coatings will also be described.

  20. Advances and directions of ion nitriding/carburizing

    NASA Astrophysics Data System (ADS)

    Spalvins, Talivaldis

    1989-09-01

    Ion nitriding and carburizing are plasma activated thermodynamic processes for the production of case hardened surface layers not only for ferrous materials, but also for an increasing number of nonferrous metals. When the treatment variables are properly controlled, the use of nitrogenous or carbonaceous glow discharge medium offers great flexibility in tailoring surface/near-surface properties independently of the bulk properties. The ion nitriding process has reached a high level of maturity and has gained wide industrial acceptance, while the more recently introduced ion carburizing process is rapidly gaining industrial acceptance. The current status of plasma mass transfer mechanisms into the surface regarding the formation of compound and diffusion layers in ion nitriding and carbon build-up ion carburizing is reviewed. In addition, the recent developments in design and construction of advanced equipment for obtaining optimized and controlled case/core properties is summarized. Also, new developments and trends such as duplex plasma treatments and alternatives to dc diode nitriding are highlighted.

  1. Advances and directions of ion nitriding/carburizing

    NASA Technical Reports Server (NTRS)

    Spalvins, Talivaldis

    1989-01-01

    Ion nitriding and carburizing are plasma activated thermodynamic processes for the production of case hardened surface layers not only for ferrous materials, but also for an increasing number of nonferrous metals. When the treatment variables are properly controlled, the use of nitrogenous or carbonaceous glow discharge medium offers great flexibility in tailoring surface/near-surface properties independently of the bulk properties. The ion nitriding process has reached a high level of maturity and has gained wide industrial acceptance, while the more recently introduced ion carburizing process is rapidly gaining industrial acceptance. The current status of plasma mass transfer mechanisms into the surface regarding the formation of compound and diffusion layers in ion nitriding and carbon build-up ion carburizing is reviewed. In addition, the recent developments in design and construction of advanced equipment for obtaining optimized and controlled case/core properties is summarized. Also, new developments and trends such as duplex plasma treatments and alternatives to dc diode nitriding are highlighted.

  2. Advanced direct coal liquefaction concepts. Final report, Volume 2

    SciTech Connect

    Berger, D.J.; Parker, R.J.; Simpson, P.L.

    1994-07-01

    Integration of innovative steps into new advanced processes have the potential to reduce costs for producing liquid fuels. In this program, objective is to develop a new approach to liquefaction that generates an all distillate product slate at a reduced cost of about US$25/barrel of crude oil equivalent. A Counterflow Reactor was developed in cooperation with GfK mbH, Germany. Advantages are low hydrogen recycle rates and low feed preheating requirements. Coal/heavy oil slurry is injected into the top of the reactor while the recycle gas and make up hydrogen is introduced into the bottom; hydrogenation products are withdrawn from the top. PU study resulted in distillable oil yields up to 74 wt % on feed (dry ash free) from coprocessing feed slurries containing 40 wt % Vesta subbituminous coal and 60 wt % Cold Lake heavy vacuum tower bottoms. Technologies developed separately by CED and ARC were combined. A 1-kg/hr integrated continuous flow bench scale unit was constructed at the ARC site in Devon, Alberta, based on modifications to a unit at Nisku, Alberta (the modified unit was used in the preliminary economic evaluation).

  3. Status and future directions for advanced accelerator research - conventional and non-conventional collider concepts

    SciTech Connect

    Siemann, R.H.

    1997-01-01

    The relationship between advanced accelerator research and future directions for particle physics is discussed. Comments are made about accelerator research trends in hadron colliders, muon colliders, and e{sup +}3{sup {minus}} linear colliders.

  4. Advance medical directives: a proposed new approach and terminology from an Islamic perspective.

    PubMed

    Al-Jahdali, Hamdan; Baharoon, Salim; Al Sayyari, Abdullah; Al-Ahmad, Ghiath

    2013-05-01

    Advance directives are specific competent consumers' wishes about future medical plans in the event that they become incompetent. Awareness of a patient's autonomy particularly, in relation to their right to refuse or withdraw treatment, a right for the patient to die from natural causes and interest in end of life issues were among the main reasons for developing and legalizing advance medical directives in developed countries. However, in many circumstances cultural and religious aspects are among many factors that can hamper implementation of advance directives. Islam and Muslims in general have a good understanding of death and dying. Islam allows the withholding or withdrawal of treatments in some cases where the intervention is considered futile. However, there is lack of literature and debate about such issues from an Islamic point of view. This article provides the Islamic perspective with regards to advance medical directive with the hope that it will generate more thoughts and evoke further discussion on this important topic.

  5. Middle-Aged Independent-Living African Americans' Selections for Advance Directives: A Case Study

    ERIC Educational Resources Information Center

    McDaniel, Brenda J.

    2013-01-01

    The purpose of this collective embedded qualitative case study was to examine the perspectives of three middle-aged independent-living African Americans who had participated in the process of advance care planning (ACP) and completed at least two advance directives (ADs), a Durable Power of Attorney for Health Care (DPAHC) and a Living Will (LW).…

  6. From Nurse to Nurse Anesthetist: The Influence of Age and Gender on Professional Socialization and Career Commitment of Advanced Practice Nurses.

    ERIC Educational Resources Information Center

    Waugaman, Wynne R.; Lohrer, Donna J.

    2000-01-01

    A survey of 1,106 student nurse anesthetists (40% male) showed that increasing age was negatively correlated with socioeconomic rewards. Male gender was positively correlated with administrative/supervisory roles, female gender with holistic patient care. Men achieved socialization more readily in occupational orientation. (SK)

  7. Executive Function in SLI: Recent Advances and Future Directions.

    PubMed

    Kapa, Leah L; Plante, Elena

    2015-09-01

    This paper provides a review of recent research on executive function abilities in children with specific language impairment (SLI). Across several studies, children with SLI are reported to perform worse than typically developing peers on measures of sustained attention, working memory, inhibition, and attention shifting. However, few studies have considered multiple executive function components simultaneously and even fewer have examined the underlying relationship between executive function deficits and impaired language acquisition. We argue that in order to fully understand the nature of executive function deficits in SLI, the field must move past simply identifying weaknesses to instead test models of executive function development and explore the nature of the relationship between executive function and language. Future research directions are recommended in order to achieve these goals.

  8. African Cultural Concept of Death and the Idea of Advance Care Directives

    PubMed Central

    Ekore, Rabi Ilemona; Lanre-Abass, Bolatito

    2016-01-01

    An advance care directive is a person's oral or written instructions about his or her future medical care, if he or she becomes unable to communicate. It may be in written or oral form. Africans ordinarily do not encourage the contemplation of death or any discussion about their own or their loved ones’ death. According to the African belief system, life does not end with death, but continues in another realm. Becoming an ancestor after death is a desirable goal of every individual, a feat which cannot be achieved if an individual asks for an unnatural death by attempting to utilize advance care directives. Advance care directives are considered to be too individualistic for communitarian societies such as Africa. Coupled with the communitarian nature of African societies are issues such as lack of awareness of advance directives, fear of death and grief, and the African cultural belief system, which are potential barriers to the utilization of advance care directives in the African setting. Hence, the need for culture sensitivity which makes it imperative that patient's family and loved ones are carried along as far as possible, without compromising the autonomy of the patient in question when utilizing advance care directives. PMID:27803556

  9. Integrating Advanced Practice Nurses in Home Care. Recommendations for a Teaching Home Care Program.

    ERIC Educational Resources Information Center

    Mitty, Ethel; Mezey, Mathy

    1998-01-01

    A telephone survey of home care agencies and providers revealed a need for the following: evidence of the effectiveness of nurse practitioners in home care, regulatory and financial support for nurse practitioner home care, and development of home care agencies as clinical sites for training. (SK)

  10. Leading the revolution in nursing practice: advancing health in the digital age.

    PubMed

    Porter-O'Grady, Tim

    2014-06-01

    Nursing is on the verge of a major shift in both its work and its value due to increasing pressure to move out of acute-care hospitals and into the community; and the influence of digitization in how nurses are able to provide care.

  11. Updating the definition and role of public health nursing to advance and guide the specialty.

    PubMed

    Bekemeier, Betty; Walker Linderman, Tessa; Kneipp, Shawn; Zahner, Susan J

    2015-01-01

    National changes in the context for public health services are influencing the nature of public health nursing practice. Despite this, the document that defines public health nursing as a specialty--The Definition and Role of Public Health Nursing--has remained in wide use since its publication in 1996 without a review or update. With support from the American Public Health Association (APHA) Public Health Nursing Section, a national Task Force, was formed in November 2012 to update the definition of public health nursing, using processes that reflected deliberative democratic principles. A yearlong process was employed that included a modified Delphi technique and various modes of engagement such as online discussion boards, questionnaires, and public comment to review. The resulting 2013 document consisted of a reaffirmation of the one-sentence 1996 definition, while updating supporting documentation to align with the current social, economic, political, and health care context. The 2013 document was strongly endorsed by vote of the APHA Public Health Nursing Section elected leadership. The 2013 definition and document affirm the relevance of a population-focused definition of public health nursing to complex systems addressed in current practice and articulate critical roles of public health nurses (PHN) in these settings.

  12. Answering the question, "what is a clinical nurse leader?": transition experience of four direct-entry master's students.

    PubMed

    Bombard, Emily; Chapman, Kimberly; Doyle, Marcy; Wright, Danielle K; Shippee-Rice, Raelene V; Kasik, Dot Radius

    2010-01-01

    Understanding the experience of students learning the clinical nurse leader (CNL) role can be useful for faculty, preceptors, staff nurses, and interdisciplinary team members who guide them. This article analyzes the experience of four direct-entry master's students in the first cohort to complete the CNL curriculum and to sit for the pilot CNL certification examination. Using action research methodology, the students worked with the clinical immersion practicum faculty and a writing consultant to develop the study purpose, collect and analyze data, and prepare a manuscript. The main theme that emerged was, answering the question, "what is a CNL?" Subthemes supporting the main theme involved coming to the edge, trusting the process, rounding the corner, and valuing becoming. The analysis confirmed the value the CNL offers as a new vision to nursing education and practice. The students offered suggestions for the CNL curriculum and practicum.

  13. Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

    PubMed

    Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

    2007-08-01

    Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

  14. Community of inquiry model: advancing distance learning in nurse anesthesia education.

    PubMed

    Pecka, Shannon L; Kotcherlakota, Suhasini; Berger, Ann M

    2014-06-01

    The number of distance education courses offered by nurse anesthesia programs has increased substantially. Emerging distance learning trends must be researched to ensure high-quality education for student registered nurse anesthetists. However, research to examine distance learning has been hampered by a lack of theoretical models. This article introduces the Community of Inquiry model for use in nurse anesthesia education. This model has been used for more than a decade to guide and research distance learning in higher education. A major strength of this model learning. However, it lacks applicability to the development of higher order thinking for student registered nurse anesthetists. Thus, a new derived Community of Inquiry model was designed to improve these students' higher order thinking in distance learning. The derived model integrates Bloom's revised taxonomy into the original Community of Inquiry model and provides a means to design, evaluate, and research higher order thinking in nurse anesthesia distance education courses.

  15. Severe Impairment Rating Scale: A Useful and Brief Cognitive Assessment Tool for Advanced Dementia for Nursing Home Residents.

    PubMed

    Yeo, Cindy; Lim, Wee Shiong; Chan, Mark; Ho, Xin Qin; Anthony, Philomena Vasantha; Han, Huey Charn; Chong, Mei Sian

    2016-02-01

    To investigate the utility of the Severe Impairment Rating Scale (SIRS) as a cognitive assessment tool among nursing home residents with advanced dementia, we conducted a cross-sectional study of 96 residents in 3 nursing homes with Functional Assessment Staging Test (FAST) stage 6a and above. We compared the discriminatory ability of SIRS with the Chinese version of Mini-Mental State Examination, Abbreviated Mental Test, and Clock Drawing Test. Among the cognitive tests, SIRS showed the least "floor" effect and had the best capacity to distinguish very severe (FAST stages 7d-f) dementia (area under the curve 0.80 vs 0.46-0.76 for the other tools). The SIRS had the best correlation with FAST staging (r = -.59, P < .01) and, unlike the other 3 tools, exhibited only minimal change in correlation when adjusted for education and ethnicity. Our results support the utility of SIRS as a brief cognitive assessment tool for advanced dementia in the nursing home setting.

  16. Advancing the Field Elder Abuse: Future Directions and Policy Implications

    PubMed Central

    Dong, XinQi

    2012-01-01

    Elder abuse, sometime called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse, neglect (caregiver neglect and self-neglect), and financial exploitation. Evidence suggests that 1 out of 10 older adult experiences some form of elder abuse, and only 1 of out 25 cases are actually reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy dealing with the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow/Health and Aging Policy Fellow working with Administration on Community Living (ACL) (Previously known at Administration on Aging (AoA)) for the last two years, I will describe the major functions of the ACL; and highlight on two major pieces of federal legislation: The Older Americans Act (OAA) and the Elder Justice Act (EJA). Moreover, I will highlight major research gaps and future policy relevant research directions for the field of elder abuse. PMID:23110488

  17. Advances in directional borehole radar data analysis and visualization

    USGS Publications Warehouse

    Smith, D.V.G.; Brown, P.J.

    2002-01-01

    The U.S. Geological Survey is developing a directional borehole radar (DBOR) tool for mapping fractures, lithologic changes, and underground utility and void detection. An important part of the development of the DBOR tool is data analysis and visualization, with the aim of making the software graphical user interface (GUI) intuitive and easy to use. The DBOR software system consists of a suite of signal and image processing routines written in Research Systems' Interactive Data Language (IDL). The software also serves as a front-end to many widely accepted Colorado School of Mines Center for Wave Phenomena (CWP) Seismic UNIX (SU) algorithms (Cohen and Stockwell, 2001). Although the SU collection runs natively in a UNIX environment, our system seamlessly emulates a UNIX session within a widely used PC operating system (MicroSoft Windows) using GNU tools (Noer, 1998). Examples are presented of laboratory data acquired with the prototype tool from two different experimental settings. The first experiment imaged plastic pipes in a macro-scale sand tank. The second experiment monitored the progress of an invasion front resulting from oil injection. Finally, challenges to further development and planned future work are discussed.

  18. Natural History of Feeding Tube Use in Nursing Home Residents with Advanced Dementia

    PubMed Central

    Kuo, Sylvia; Rhodes, Ramona L.; Mitchell, Susan L.; Mor, Vincent; Teno, Joan M.

    2009-01-01

    Objectives Despite the evidence that feeding tube use in persons with advanced dementia is not associated improved outcomes, there remains striking area variation in their use. Yet, little is known about the national incidence of feeding tube insertions, the circumstances of their insertion, and post-insertion health care utilization. Design Secondary analysis of Minimum Data Set merged onto Medicare Claims Files Setting and Participants Nursing home residents (NHR) without a feeding tube Measurements NHR were followed for up to one year to see whether a feeding tube was inserted and then followed for one year post insertion to examine health care utilization and survival. Results The incidence of feeding tube insertion was 53.6/1000 residents. The majority (68.1%) of feeding tube insertions were performed in an acute care hospital with the most common reasons for admission being pneumonia, dehydration, and dysphagia. One year post-insertion mortality was 64.1% with median survival of 56 days. Within one year, 19.3% of those who had a feeding tube inserted required a tube replacement or repositioning within a median 145 days after the initial insertion. Over one year, tube-feeding was associated with an average of 9.1 hospitalized days per person, 1.0 hospitalizations, 0.3 emergency room visits that did not result in a hospital admission. Conclusion The majority of feeding tubes are inserted in an acute care hospital. Feeding tube insertions are also associated with poor survival and significant rate of health care utilization post insertion. PMID:19426943

  19. Students' Attitudes toward Computers at the College of Nursing at King Saud University (KSU)

    ERIC Educational Resources Information Center

    Samarkandi, Osama Abdulhaleem

    2011-01-01

    Computer knowledge and skills are becoming essential components technology in nursing education. Saudi nurses must be prepared to utilize these technologies for the advancement of science and nursing practice in local and global communities. Little attention has been directed to students' attitudes about computer usage in academic communities in…

  20. Beyond advance directives: importance of communication skills at the end of life.

    PubMed

    Tulsky, James A

    2005-07-20

    Patients and their families struggle with myriad choices concerning medical treatments that frequently precede death. Advance directives have been proposed as a tool to facilitate end-of-life decision making, yet frequently fail to achieve this goal. In the context of the case of a man with metastatic cancer for whom an advance directive was unable to prevent a traumatic death, I review the challenges in creating and implementing advance directives, discuss factors that can affect clear decision making; including trust, uncertainty, emotion, hope, and the presence of multiple medical providers; and offer practical suggestions for physicians. Advance care planning remains a useful tool for approaching conversations with patients about the end of life. However, such planning should occur within a framework that emphasizes responding to patient and family emotions and focuses more on goals for care and less on specific treatments.

  1. Advances in Focal Plane Wavefront Estimation for Directly Imaging Exoplanets

    NASA Astrophysics Data System (ADS)

    Eldorado Riggs, A. J.; Kasdin, N. Jeremy; Groff, Tyler Dean

    2015-01-01

    To image cold exoplanets directly in visible light, an instrument on a telescope needs to suppress starlight by about 9 orders of magnitude at small separations from the star. A coronagraph changes the point spread function to create regions of high contrast where exoplanets or disks can be seen. Aberrations on the optics degrade the contrast by several orders of magnitude, so all high-contrast imaging systems incorporate one or more deformable mirrors (DMs) to recover regions of high contrast. With a coronagraphic instrument planned for the WFIRST-AFTA space telescope, there is a pressing need for faster, more robust estimation and control schemes for the DMs. Non-common path aberrations limit conventional phase conjugation schemes to medium star-to-planet contrast ratios of about 1e-6. High-contrast imaging requires estimation and control of both phase and amplitude in the same beam path as the science camera. Field estimation is a challenge since only intensity is measured; the most common approach, including that planned for WFIRST-AFTA, is to use DMs to create diversity, via pairs of small probe shapes, thereby allowing disambiguation of the electric field. Most implementations of DM Diversity require at least five images per electric field estimate and require narrowband measurements. This paper describes our new estimation algorithms that improve the speed (by using fewer images) and bandwidth of focal plane wavefront estimation. For narrowband estimation, we are testing nonlinear, recursive algorithms such as an iterative extended Kalman filter (IEKF) to use three images each iteration and build better, more robust estimates. We are also exploring the use of broadband estimation without the need for narrowband sub-filters and measurements. Here we present simulations of these algorithms with realistic noise and small signals to show how they might perform for WFIRST-AFTA. Once validated in simulations, we will test these algorithms experimentally in

  2. The future shortage of doctoral prepared nurses and the impact on the nursing shortage.

    PubMed

    Morgan, Deb; Somera, Patricia

    2014-01-01

    Nursing remains at the top of the job growth market and has the potential to positively or negatively impact changes in the delivery of health care today. Professional nurses play a crucial role in the prevention of medication errors, decreasing infection rates, and facilitating a patient's safe transition from acute care into the home environment. Nurses must make critical life-saving decisions associated with caring for the more acutely ill patient. Doctoral prepared nurses have the unique position to assist the direct care nurse because of their advanced education. The doctor in nursing practice concentrates on direct care, specifically research utilization for improved delivery of care, patient outcomes, and clinical systems management There is a future shortage of doctoral prepared nurses, and a resolution is needed. Doctoral prepared nurses with advanced degrees play an important role in mentoring the bedside nurse to promote an interdisciplinary collaborative relationship. The doctor in nursing practice has the ability to effect change in health care systems, organizations, and policy through focusing on the essence of nursing-the care.

  3. Use of modified Delphi to plan knowledge translation for decision makers: an application in the field of advanced practice nursing.

    PubMed

    Carter, Nancy; Lavis, John N; MacDonald-Rencz, Sandra

    2014-01-01

    Disseminating research to decision makers is difficult. Interaction between researchers and decision makers can identify key messages and processes for dissemination. To gain agreement on the key findings from a synthesis on the integration of advanced practice nurses, we used a modified Delphi process. Nursing decision makers contributed ideas via e-mail, discussed and clarified ideas face to face, and then prioritized statements. Sixteen (89%) participated and 14 (77%) completed the final phase. Priority key messages were around access to care and outcomes. The majority identified "NPs increase access to care" and "NPs and CNSs improve patient and system outcomes" as priority messaging statements. Participants agreed policy makers and the public were target audiences for messages. Consulting with policy makers provided the necessary context to develop tailored policy messages and is a helpful approach for research dissemination.

  4. Incorporating a health policy practicum in a graduate training program to prepare advanced practice nursing health services researchers.

    PubMed

    DiCenso, Alba; Housden, Laura; Heale, Roberta; Carter, Nancy; Canitz, Brenda; MacDonald-Rencz, Sandra; Buckley, Christine Rieck

    2012-11-01

    Health services research benefits from the active engagement of researchers and policy makers from generation through to application of research-based knowledge. One approach to help graduate students learn about the policy world is through participation in a policy practicum. This is an opportunity to work for a defined period of time in a setting where policy decisions are made. This article focuses on the integration of the policy practicum into graduate nursing education for advanced practice nurses. Ten graduate students and two postdoctoral fellows who had recently completed their practicums and three policy makers who had recently supervised students in provincial, federal, and international practicum projects were invited to submit a narrative about the experience. Based on qualitative analysis of the narratives, this article outlines objectives of the practicum, the policy practicum journey, student learning, and finally, the benefits and challenges of the experience.

  5. Effect of simulation on knowledge of advanced cardiac life support, knowledge retention, and confidence of nursing students in Jordan.

    PubMed

    Tawalbeh, Loai I; Tubaishat, Ahmad

    2014-01-01

    This study examined the effect of simulation on nursing students' knowledge of advanced cardiac life support (ACLS), knowledge retention, and confidence in applying ACLS skills. An experimental, randomized controlled (pretest-posttest) design was used. The experimental group (n = 40) attended an ACLS simulation scenario, a 4-hour PowerPoint presentation, and demonstration on a static manikin, whereas the control group (n = 42) attended the PowerPoint presentation and a demonstration only. A paired t test indicated that posttest mean knowledge of ACLS and confidence was higher in both groups. The experimental group showed higher knowledge of ACLS and higher confidence in applying ACLS, compared with the control group. Traditional training involving PowerPoint presentation and demonstration on a static manikin is an effective teaching strategy; however, simulation is significantly more effective than traditional training in helping to improve nursing students' knowledge acquisition, knowledge retention, and confidence about ACLS.

  6. Direct Reimbursement of Nurse Practitioners in Health Insurance Plans of Research Universities.

    ERIC Educational Resources Information Center

    Scott, Cynthia Luna; Harrison, O. Anne

    1990-01-01

    Results of a survey of 77 public research universities indicated that, in spite of the presence of state legislation for third-party reimbursement of nursing services, legislation is not being implemented in many states by employers in their purchase of group health insurance policies. Nursing services covered by these policies include private…

  7. 22 CFR 72.30 - Provisions in a will or advanced directive regarding disposition of remains.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... WELFARE OF AMERICANS, THEIR PROPERTY AND ESTATES DEATHS AND ESTATES Real Property Overseas Belonging to A... disposition of remains. United States state law regarding advance directives, deaths and estates include provisions regarding a person's right to direct disposition of remains. Host country law may or may...

  8. Self-directed learning in the context of a nursing curriculum: development of a learning plan.

    PubMed

    Majumdar, B

    1996-06-01

    The rapid pace at which biological health breakthroughs and advancements in technology occur is creating unique challenges to health care programmes. The curricula of all health care programmes will need to be set in learning environments where students will be able to develop learning skills that are transportable across situations, over a whole lifetime. This article attempts to focus on self-directed learning (SDL) concepts and the development of a learning contract/plan, including the roles of both the student and faculty in self-learning approaches and contractual development.

  9. Embedding advance directives in routine care for persons with serious mental illness: implementation challenges.

    PubMed

    Kemp, Kathleen; Zelle, Heather; Bonnie, Richard J

    2015-01-01

    For people with serious mental illness, research demonstrates the potential positive effects of having an advance directive with specific instructions for mental health care. The Commonwealth of Virginia has undertaken efforts to incorporate the completion of psychiatric advance directives into routine mental health services for individuals with serious mental illness. The inherent complexities of advance directives-a single legal tool for use by a heterogeneous array of consumers, providers, and organizations-have led to more barriers than had been anticipated. This article describes challenges encountered in the first three years of implementation efforts. Data are from feedback on early training attempts and experiences of staff at pilot sites and work groups convened for the implementation project. The authors describe a range of challenges, such as how to present a complete and clear message about the nature, purposes, and potential advantages of psychiatric advance directives to various audiences, in particular their use in recovery-oriented care; how to promote cross-system collaboration among potential users of these directives; and how to overcome resource constraints and sustain interest in the process. Virginia's experience reinforces the importance of developing multifaceted implementation strategies, such as the creation of informational and training tools to spread implementation more effectively, the identification of "champions" or staff members who are invested in implementation, and the development of multiple approaches to facilitating completion of advance directives by consumers.

  10. Advancing nursing home practice: the International Association of Geriatrics and Gerontology Recommendations.

    PubMed

    Tolson, Debbie; Morley, John E; Rolland, Yves; Vellas, Bruno

    2011-01-01

    Recognition of the urgent need to improve the provision of long-term care, as well as the known variations in standards of nursing home care around the world, prompted the International Association of Geriatrics and Gerontology (IAGG), in association with the World Health Organization (WHO), to form a task force. This task force was charged with the identification of the key concerns, research priorities, and actions that would enhance the care provided to older people in nursing homes. Nurses are equipped with the knowledge to take a leadership role in the IAGG/WHO initiative, and the task force eagerly seeks their input.

  11. Understanding Advance Care Documents: What the Nurse Advocate Needs to Know.

    PubMed

    Kellogg, Erika

    2017-04-03

    The emergency department is a critical care area for those with immediate health care needs, and death is not an uncommon outcome. The discussion regarding end-of-life care is often a subject nurses feel uncomfortable or unprepared to address. Additionally, nurses often encounter obstacles when providing end-of-life care in the emergency department environment. It is vital that emergency nurses are educated about the many aspects of end-of-life care to feel better prepared to address the topic which will ultimately improve patient care.

  12. Goals of telephone nursing work - the managers’ perspectives: a qualitative study on Swedish healthcare direct

    PubMed Central

    2014-01-01

    Background Swedish Healthcare Direct (SHD) receives 6 million calls yearly and aims at increased public sense of security and healthcare efficiency. Little is known about what SHD managers perceive as the primary goals of telephone nursing (TN) work and how the organisation matches goals of health promotion and equitable healthcare, so important in Swedish healthcare legislation. The aim of the study was to explore and describe what the SHD managers perceive as the goals of TN work and how the managers view health promotion and implementation of equitable healthcare with gender as example at SHD. Methods The study was qualitative using an exploratory and descriptive design. All 23 managers employed at SHD were interviewed and data analysis used deductive directed content analysis. Results The findings reveal four themes describing the goals of TN work as recommended by the SHD managers. These are: ‘create feelings of trust’, ‘achieve patient safety’, ‘assess, refer and give advice’, and ‘teach the caller’. Most of the managers stated that health promotion should not be included in the goals, whereas equitable healthcare was viewed as an important issue. Varying suggestions for implementing equitable healthcare were given. Conclusions The interviewed managers mainly echoed the organisational goals of TN work. The managers’ expressed goal of teaching lacked the caller learning components highlighted by telenurses in previous research. The fact that health promotion was not seen as important indicates a need for SHD to clarify its goals as the organisation is part of the Swedish healthcare system, where health promotion should always permeate work. Time used for health promotion and dialogues in a gender equitable manner at SHD is well invested as it will save time elsewhere in the health care system, thereby facing one of the challenges of European health systems. PMID:24762193

  13. Cost-utility analysis of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses.

    PubMed

    Kaitani, Toshiko; Nakagami, Gojiro; Iizaka, Shinji; Fukuda, Takashi; Oe, Makoto; Igarashi, Ataru; Mori, Taketoshi; Takemura, Yukie; Mizokami, Yuko; Sugama, Junko; Sanada, Hiromi

    2015-01-01

    The high prevalence of severe pressure ulcers (PUs) is an important issue that requires to be highlighted in Japan. In a previous study, we devised an advanced PU management protocol to enable early detection of and intervention for deep tissue injury and critical colonization. This protocol was effective for preventing more severe PUs. The present study aimed to compare the cost-effectiveness of the care provided using an advanced PU management protocol, from a medical provider's perspective, implemented by trained wound, ostomy, and continence nurses (WOCNs), with that of conventional care provided by a control group of WOCNs. A Markov model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness ratio of advanced PU management compared with conventional care. The number of quality-adjusted life-years gained, and the cost in Japanese yen (¥) ($US1 = ¥120; 2015) was used as the outcome. Model inputs for clinical probabilities and related costs were based on our previous clinical trial results. Univariate sensitivity analyses were performed. Furthermore, a Bayesian multivariate probability sensitivity analysis was performed using Monte Carlo simulations with advanced PU management. Two different models were created for initial cohort distribution. For both models, the expected effectiveness for the intervention group using advanced PU management techniques was high, with a low expected cost value. The sensitivity analyses suggested that the results were robust. Intervention by WOCNs using advanced PU management techniques was more effective and cost-effective than conventional care.

  14. Advancing medical-surgical nursing practice: improving management of the changing patient condition.

    PubMed

    Monroe, Heidi; Plylar, Peggy; Krugman, Mary

    2014-01-01

    Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.

  15. Factors associated with the use of advanced practice nurses/physician assistants in a fee-for-service nursing home practice: a comparison with primary care physicians.

    PubMed

    Bakerjian, Debra; Harrington, Charlene

    2012-07-01

    The purpose of this research was to examine factors associated with the use of advanced practice nurse and physician assistant (APN/PA) visits to nursing home (NH) patients compared with those by primary care physicians (PCPs). This was a secondary analysis using Medicare claims data. General estimation equations were used to determine the odds of NH residents receiving APN/PA visits. Ordinary least squares analyses were used to examine factors associated with these visits. A total of 5,436 APN/PAs provided care to 27% of 129,812 residents and were responsible for 16% of the 1.1 million Medicare NH fee-for-service visits in 2004. APN/PAs made an average of 33 visits annually compared with PCPs (21 visits). Neuropsychiatric and acute diagnoses and patients with a long-stay status were associated with more APN/PA visits. APN/PAs provide a substantial amount of care, but regional variations occur, and Medicare regulations constrain the ability of APN/PAs to substitute for physician visits.

  16. Impact of Advanced Health Care Directives on Treatment Decisions by Physicians in Patients with Acute Stroke

    PubMed Central

    Qureshi, Adnan I; Chaudhry, Saqib A.; Connelly, Bo; Abott, Emily; Janjua, Tariq; Kim, Stanley H.; Miley, Jefferson T.; Rodriguez, Gustavo J.; Uzun, Guven; Watanabe, Masaki

    2012-01-01

    Background The implementation of advance health care directives, prepared by almost half of the adult population in United States remains relatively under studied. We determined the impact of advance health care directives on treatment decisions by multiple physicians in stroke patients. Methods A de-identified summary of clinical and radiological records of 28 patients with stroke was given to six stroke physicians who were not involved in the care of the patients. Each physician independently rated 28 treatment decisions per patient in the presence or absence of advance health care directives 1 month apart to allow memory washout. The percentage agreement to treat/intervene per patient and proportion of treatment withheld as a group were estimated for each of the 28 treatment decision items. We also determined the interobserver reliability between the two raters (attorneys) in interpretation of 6 items characterizing the adequacy of documentation within the 28 advance health care directives. Results The percentage agreement among physician raters for treatment decisions in 28 stroke patients was highest for treatment of hyperpyrexia (100%, 100%) and lowest for intensive care unit monitoring duration based on family-physician considerations outside of accepted criteria within institution (68%, 69%) in presence and absence of advance care health directives. The physician rater agreement in choosing “yes” was highest for “routine complexity” treatment decisions and lowest for “moderate complexity” treatment decisions. The choice of withholding treatment in routine complexity,” “moderate complexity,” or “high complexity” treatment decisions was remarkably similar among raters in presence or absence of advance care health directives. The only treatment decision that showed an impact of advance care health directives was intensive care unit monitoring withheld in 32% of treatment decisions in presence of directives (compared with 8% in the absence

  17. Advance Directives

    MedlinePlus

    ... Employment Become a Supplier Report Fraud or Abuse Global Health ACS CAN Sign up for Email Policies Our Volunteers More ACS Sites Bookstore Shop Cancer Atlas Press Room Cancer Statistics Center Volunteer Learning Center Follow Us Twitter Facebook ...

  18. Nursing and information and communication technology (ICT): a discussion of trends and future directions.

    PubMed

    While, Alison; Dewsbury, Guy

    2011-10-01

    This paper traces the development of information and communication (ICT) within health care and the emergence of telehealth as a key component of modern health care delivery as health care moves from the 'face to face age' to the 'information age'. The paper examines the interface of ICT and nursing practice and highlights the limited evidence relating to the nursing contribution within telehealth particularly beyond data input and output analysis for other health care personnel. Additionally, the absence of research relating to the impact of ICT upon nurses and their working lives is identified. The paper concludes that nurses need to engage more fully with ICT so that they contribute to shaping the care system and emerge as leaders of the new care systems delivering future clinical activity.

  19. The Development of Evidence Briefs to Transfer Knowledge About Advanced Practice Nursing Roles to Providers, Policymakers and Administrators.

    PubMed

    Kilpatrick, Kelley; Carter, Nancy; Bryant-Lukosius, Denise; Charbonneau-Smith, Renee; DiCenso, Alba

    2015-03-01

    The transfer of health-related research knowledge between producers and users is a complex, dynamic and iterative process. There has been little research describing the preferred knowledge transfer strategies used by different stakeholder groups, including healthcare providers, policymakers and administrators. The purpose of the survey was to gain an understanding of the content and preferred dissemination strategies of knowledge users of briefing notes about the effectiveness of advanced practice nursing (APN) roles in Canada. An on-line cross-sectional survey was conducted from December 2011 to January 2012. Purposeful sampling was used to identify the target audience. The questionnaire included six items. The response rate was 44% (n=75/170). Participants identified that the briefing note should concisely summarize definitions for APN roles and information about the safety, effectiveness, cost savings and effective role implementation strategies. Multiple approaches were favoured to disseminate the information. Preferred dissemination strategies included personalized emails, meeting with briefing note recipients, engaging nurse practitioners and clinical nurse specialists in organizations where APN roles have been successfully implemented, engaging the media and using social media. The use of briefing notes has shown promise. More research is needed to evaluate the effectiveness of tailored briefing notes.

  20. Unfractionated heparin: a nursing dilemma.

    PubMed

    Oertel, Lynn B

    2004-08-01

    Nurses face challenges in all aspects of their practice, especially with administering and monitoring drugs in a safe, effective manner. Key factors known to affect drug administration include general drug knowledge, formal nurse education, continuing education needs, clinical experience, and the nationwide nursing shortage. Other factors are advances in technologic aids and quality improvement initiatives. Emphasis on patient safety is growing, especially as it relates to drug therapy and high-alert drugs such as unfractionated heparin (UFH). Specific interventions related to UFH administration can enhance patient care management. Because nurses are at the site of direct patient care, they are often in an opportune position for identifying medication errors. At the same time, and most important, nurses need to collaborate with other health care professionals to actively develop solutions to minimize these errors. Adopting a systems approach and working collaboratively with an interdisciplinary team can result in improved patient outcomes.

  1. End-of-life care in the 21st century: advance directives in universal rights discourse.

    PubMed

    Besirević, Violeta

    2010-03-01

    This article explores universal normative bases that could help to shape a workable legal construct that would facilitate a global use of advance directives. Although I believe that advance directives are of universal character, my primary aim in approaching this issue is to remain realistic. I will make three claims. First, I will argue that the principles of autonomy, dignity and informed consent, embodied in the Oviedo Convention and the UNESCO Declaration on Bioethics and Human Rights, could arguably be regarded as universal bases for the global use of advance directives. Second, I will demonstrate that, despite the apparent consensus of ethical authorities in support of their global use, it is unlikely, for the time being, that such consensus could lead to unqualified legal recognition of advance directives, because of different understandings of the nature of the international rules, meanings of autonomy and dignity which are context-specific and culture-specific, and existing imperfections that make advance directives either unworkable or hardly applicable in practice. The third claim suggests that the fact that the concept of the advance directive is not universally shared does not mean that it should not become so, but never as the only option in managing incompetent patients. A way to proceed is to prioritize work on developing higher standards in managing incompetent patients and on progressing towards the realization of universal human rights in the sphere of bioethics, by advocating a universal, legally binding international convention that would outlaw human rights violations in end-of-life decision-making.

  2. Effects of an advanced nursing assistant education program on job satisfaction, turnover rate, assistant education program on and clinical outcomes.

    PubMed

    Brown, Megan; Redfern, Roberta E; Bressler, Katrina; Swicegood, Tamara May; Molnar, Marianne

    2013-10-01

    Certified nursing assistants (CNAs) have become an integral part of the health care system, spend the most amount of time with residents, and yet have the least amount of training. Recent reports demonstrate that CNAs believe their salary is not commensurate with their workload, and turnover rates in this field have indicated low job satisfaction. In light of these issues, we developed an advanced training program for CNAs in our institution to determine whether investing in our employees would increase job satisfaction and therefore impact turnover rates and clinical outcomes. Although overall job satisfaction improved slightly during the study period, satisfaction with training offered was the only area significantly affected by the intervention; however, significant decreases in turnover rates were observed between the pre- and postintervention periods. Clinical indicators were slightly improved, and the number of resident urinary tract infections decreased significantly. Offering an advanced training program for CNAs may be an effective way to improve morale, turnover rates, and clinical outcomes.

  3. Advanced Practice Registered Nurses and Physician Assistants in Sleep Centers and Clinics: A Survey of Current Roles and Educational Background

    PubMed Central

    Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E.; Rogers, Ann E.

    2014-01-01

    Study Objectives: To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Methods: Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Results: Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through “on the job” training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. Conclusions: APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap. Citation: Colvin L, Cartwright Ann, Collop N, Freedman N, McLeod D, Weaver TE, Rogers AE. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. J Clin Sleep Med 2014;10(5):581-587. PMID:24812545

  4. The Effects of Direction of Exertion, Path, and Load Placement in Nursing Cart Pushing and Pulling Tasks: An Electromyographical Study

    PubMed Central

    Kao, Huei Chu; Lin, Chiuhsiang Joe; Lee, Yung Hui; Chen, Su Huang

    2015-01-01

    The purpose of this study was to explore the effects of direction of exertion (DOE) (pushing, pulling), path (walking in a straight line, turning left, walking uphill), and load placement (LP) (the 18 blocks were indicated by X, Y and Z axis; there were 3 levels on the X axis, 2 levels on the Y axis, and 3 levels on the Z axis) on muscle activity and ratings of perceived exertion in nursing cart pushing and pulling tasks. Ten participants who were female students and not experienced nurses were recruited to participate in the experiment. Each participant performed 108 experimental trials in the study, consisting of 2 directions of exertion (push and pull), 3 paths, and 18 load placements (indicated by X, Y and Z axes). A 23kg load was placed into one load placement. The dependent variables were electromyographic (EMG) data of four muscles collected bilaterally as follows: Left (L) and right (R) trapezius (TR), flexor digitorum superficialis (FDS), extensor digitorum (ED), and erector spinae (ES) and subjective ratings of perceived exertion (RPE). Split-split-plot ANOVA was conducted to analyze significant differences between DOE, path, and LP in the EMG and RPE data. Pulling cart tasks produced a significantly higher activation of the muscles (RTR:54.4%, LTR:50.3%, LFDS:57.0%, LED:63.4%, RES:40.7%, LES:36.7%) than pushing cart tasks (RTR:42.4%, LTR:35.1%, LFDS:32.3%, LED:55.1%, RES:33.3%, LES:32.1%). A significantly greater perceived exertion was found in pulling cart tasks than pushing cart tasks. Significantly higher activation of all muscles and perceived exertion were observed for walking uphill than walking in a straight line and turning left. Significantly lower muscle activity of all muscles and subject ratings were observed for the central position on the X axis, the bottom position on the Y axis, and the posterior position on the Z axis. These findings suggest that nursing staff should adopt forward pushing when moving a nursing cart, instead of backward

  5. Advance directives are the solution to Dr Campbell's problem for voluntary euthanasia.

    PubMed Central

    Flew, A

    1999-01-01

    Dr Neil Campbell suggests that when patients suffering extremes of protracted pain ask for help to end their lives, their requests should be discounted as made under compulsion. I contend that the doctors concerned should be referred to and then act upon advance directives made by those patients when of sound and calm mind and afflicted by no such intolerable compulsion. PMID:10390680

  6. Completion of Advance Directives: Do Social Work Preadmission Interviews Make a Difference?

    ERIC Educational Resources Information Center

    Johnson, Yvonne M.; Stadel, Vivian L.

    2007-01-01

    Objectives: This study tests the efficacy of a preadmission, educational interview on advance directives, in this case, health care proxies (HCPs) offered to elective, orthopedic patients. Method: Using a quasi-experimental design, participants (n = 54) are assigned to either treatment group (who received the educational interview, conducted by a…

  7. Status and future directions for advanced accelerator research-conventional and non-conventional collider concepts

    SciTech Connect

    Siemann, R.H.

    1997-03-01

    The relationship between advanced accelerator research and future directions for particle physics is discussed. Comments are made about accelerator research trends in hadron colliders, muon colliders, and e{sup +}e{sup {minus}} linear colliders. {copyright} {ital 1997 American Institute of Physics.}

  8. Behavioral and Cognitive-Behavioral Approaches to Chronic Pain: Recent Advances and Future Directions.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1992-01-01

    Reviews and highlights recent research advances and future research directions concerned with behavioral and cognitive-behavioral approaches to chronic pain. Reviews assessment research on studies of social context of pain, relationship of chronic pain to depression, cognitive variables affecting pain, and comprehensive assessment measures.…

  9. Do Geriatricians Practice What They Preach?: Geriatricians' Personal Establishment of Advance Directives

    ERIC Educational Resources Information Center

    Lester, Paula E.; Sykora, Alzbeta; Wolf-Klein, Gisele P.; Pekmezaris, Renee; Auerbach, Charles; Feuerman, Martin

    2009-01-01

    Previous research has been conducted regarding preferences of physicians for life-sustaining treatments for themselves, but there is a dearth of data on personal use of advance directives (ADs) by geriatricians specifically. Using a phone survey, we contacted all graduates of the geriatric fellowship program to assess their personal use of advance…

  10. Joint crisis plans and psychiatric advance directives in German psychiatric practice.

    PubMed

    Radenbach, Katrin; Falkai, Peter; Weber-Reich, Traudel; Simon, Alfred

    2014-05-01

    This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded (response rate: 22.8%). Their answers demonstrate that in their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive.

  11. Evaluation of the Penn Macy Initiative To Advance Academic Nursing Practice.

    ERIC Educational Resources Information Center

    Evans, Lois K.; Swan, Beth Ann; Lang, Norma E.

    2003-01-01

    In the Penn Macy Initiative, 21 nursing schools participated in summer institutes and follow-up consultations to refine practice. Evaluation data from participants' daily and postinstitute feedback, institutional self-evaluations, and comparison of school accomplishments identified critical indicators of progress in academic practice. A key…

  12. The Effect of Advance Directive Completion on Hospital Care Among Chronically Homeless Persons: a Prospective Cohort Study.

    PubMed

    Leung, Alexander K; To, Matthew J; Luong, Linh; Vahabi, Zahra Syavash; Gonçalves, Victor L; Song, John; Hwang, Stephen W

    2017-02-01

    Advance care planning is relevant for homeless individuals because they experience high rates of morbidity and mortality. The impact of advance directive interventions on hospital care of homeless individuals has not been studied. The objective of this study was to determine if homeless individuals who complete an advance directive through a shelter-based intervention are more likely to have information from their advance directive documented and used during subsequent hospitalizations. The advance directive included preferences for life-sustaining treatments, resuscitation, and substitute decision maker(s). A total of 205 homeless men from a homeless shelter for men in Toronto, Canada, were enrolled in the study and offered an opportunity to complete an advance directive with the guidance of a trained counselor from April to June 2013. One hundred and three participants chose to complete an advance directive, and 102 participants chose to not complete an advance directive. Participants were provided copies of their advance directives. In addition, advance directives were electronically stored, and hospitals within a 1.0-mile radius of the shelter were provided access to the database. A prospective cohort study was performed using chart reviews to ascertain the documentation, availability, and use of advance directives, end-of-life care preferences, and medical treatments during hospitalizations over a 1-year follow-up period (April 2013 to June 2014) after the shelter-based advance directive intervention. Chart reviewers were blinded as to whether participants had completed an advance directive. The primary outcome was documentation or use of an advance directive during any hospitalization. The secondary outcome was documentation of end-of-life care preferences, without reference to an advance directive, during any hospitalization. After unblinding, charts were studied to determine whether advance directives were available, hospital care was consistent with

  13. Advance directives in english and French law: different concepts, different values, different societies.

    PubMed

    Horn, Ruth Judith

    2014-03-01

    In Western societies advance directives are widely recognised as important means to extend patient self-determination under circumstances of incapacity. Following other countries, England and France have adopted legislation aiming to clarify the legal status of advance directives. In this paper, I will explore similarities and differences in both sets of legislation, the arguments employed in the respective debates and the socio-political structures on which these differences are based. The comparison highlights how different legislations express different concepts emphasising different values accorded to the duty to respect autonomy and to protect life, and how these differences are informed by different socio-political contexts. Furthermore each country associates different ethical concerns with ADs which raise doubts about whether these directives are a theoretical idea which is hardly applicable in practice.

  14. The desire to die: making treatment decisions for suicidal patients who have an advance directive.

    PubMed

    Salter, Erica K

    2014-01-01

    This article enumerates and critically examines the potential grounds on which we might treat the case of a patient with an advance directive who attempted suicide, differently from one whose injuries were the result of an accident. Grounds for differentiation are distilled into two potential justifications. The first addresses the concern that withholding or withdrawing care from a patient with self-inflicted injuries would be aiding and abetting suicide.The second examines concerns about the patient's decisionmaking capacity. Ultimately, it is argued that while there might be legitimate reasons to hold the advance directive of a suicidal patient to a different standard of scrutiny, the fact that the patient's medical state was self-inflicted should not, in and of itself, necessarily invalidate the guidance of the directive. Finally, four practical recommendations are offered for negotiating similar cases.

  15. End-of-life communication in Korean older adults: With focus on advance care planning and advance directives.

    PubMed

    Shin, Dong Wook; Lee, Ji Eun; Cho, BeLong; Yoo, Sang Ho; Kim, SangYun; Yoo, Jun-Hyun

    2016-04-01

    The present article aimed to provide a comprehensive review of current status of end-of-life (EOL) care and sociocultural considerations in Korea, with focus on the EOL communication and use of advance directives (AD) in elderly Koreans. Through literature review, we discuss the current status of EOL care and sociocultural considerations in Korea, and provide a look-ahead. In Korea, patients often receive life-sustaining treatment until the very end of life. Advance care planning is rare, and most do-not-resuscitate decisions are made between the family and physician at the very end of patient's life. Koreans, influenced mainly by Confucian tradition, prefer a natural death and discontinuation of life-sustaining treatment. Although Koreans generally believe that death is natural and unavoidable, they tend not to think about or discuss death, and regard preparation for death as unnecessary. As a result, AD are completed by just 4.7% of the general adult population. This situation can be explained by several sociocultural characteristics including opting for natural death, wish not to burden others, preference for family involvement and trust in doctor, avoidance of talking about death, and filial piety. Patients often receive life-sustaining treatment until the very EOL, advance care planning and the use of AD is not common in Korea. This was related to unique sociocultural characteristics of Korea. A more active role of physicians, development of a more deliberate EOL discussion process, development of culturally appropriate AD and promotion of advance care planning might be required to provide good EOL care in Korea.

  16. Improving the Quality of Nursing Home Care and Medical-Record Accuracy with Direct Observational Technologies

    ERIC Educational Resources Information Center

    Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.

    2005-01-01

    Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medical record data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and…

  17. Integrating advanced writing content into a scholarly inquiry in nursing course.

    PubMed

    Mandleco, Barbara L; Bohn, Christina; Callister, Lynn C; Lassetter, Jane; Carlton, Troy

    2012-02-17

    Since there are few data examining methods to help students learn to write in a scholarly manner, the purposes of this project were to (1) evaluate students' learning of writing content integrated into a Scholarly Inquiry in Nursing course by examining differences in scores on a writing assessment taken at the beginning and end of the course; and (2) examine student confidence ratings relative to writing to see if it improved during the course. After obtaining IRB approval and informed consent, the CLIPS pre and post assessment mean scores of 82 students in a Scholarly Inquiry in Nursing course were compared using the Wilcoxon signed-rank test. Confidence ratings in formal and informal writing were also obtained from a subsample of 47 students. Mean scores improved in 12 out of 26 assessment categories related to punctuation, correct usage of words, and sentence construction. Student mean confidence ratings increased each month.

  18. Nursing students assess nursing education.

    PubMed

    Norman, Linda; Buerhaus, Peter I; Donelan, Karen; McCloskey, Barbara; Dittus, Robert

    2005-01-01

    This study assessed the characteristics of nursing students currently enrolled in nursing education programs, how students finance their nursing education, their plans for clinical practice and graduate education, and the rewards and difficulties of being a nursing student. Data are from a survey administered to a national sample of 496 nursing students. The students relied on financial aid and personal savings and earnings to finance their education. Parents, institutional scholarships, and government loans are also important sources, but less than 15% of the students took out bank loans. Nearly one quarter of the students, particularly younger and minority students, plan to enroll in graduate school immediately after graduation and most want to become advanced nursing practitioners. Most of the nursing students (88%) are satisfied with their nursing education and nearly all (95%) provided written answers to two open-ended questions. Comments collapsed into three major categories reflecting the rewards (helping others, status, and job security) and three categories reflecting the difficulties (problems with balancing demands, quality of nursing education, and the admissions process) of being a nursing student. Implications for public policymaking center on expanding the capacity of nursing education programs, whereas schools themselves should focus on addressing the financial needs of students, helping them strike a balance among their school, work, and personal/family responsibilities and modifying certain aspects of the curriculum.

  19. An innovative approach to enhance dermatology competencies for advanced practice nurses: service–learning with a migrant farm worker health clinic.

    PubMed

    Downes, Elizabeth A; Connor, Ann; Howett, Maeve

    2014-12-01

    The purpose of this article is to describe a novel service–learning opportunity for graduate nursing students that promotes competency in dermatology. A hybrid service–learning course with online didactic content is described, along with tools for evaluation of dermatology competencies. Student evaluation of the course is discussed, and selected research articles are reviewed. Advanced practice nursing and medical education frequently does not adequately prepare primary care providers to be competent in the assessment and management of dermatologic conditions. Embedding dermatology content in a service–learning program can optimize the provision of care, strengthen competencies in dermatology and inter-professional care, and allow students to gain a deeper understanding of the population with which they work. The innovative service–learning program presented is a model for advanced practice nursing education. Tools for evaluating clinical competency and courses often need validation.

  20. Exploring the theoretical basis of nursing using advanced techniques of concept analysis.

    PubMed

    Morse, J M

    1995-03-01

    In this article, the traditional methods of concept development are critiqued, and alternative methods that use qualitative methods of inquiry are presented. Variations of concept development techniques appropriate to the maturity of the concept being explored are then described, including methods for concept delineation, concept comparison, concept clarification, concept correction, and concept identification. To illustrate the application of concept development methods to nursing theory, a research program to delineate the construct of comfort is described.

  1. Diversifying the Pipeline Into Doctoral Nursing Programs: Developing the Doctoral Advancement Readiness Self-Assessment.

    PubMed

    DeWitty, Vernell P; Tabloski, Patricia A; Millett, Catherine M; Hambrick, Marion Evan; Shreffler, Megan; Downing, Christine A; Huerta, Carolina G

    2016-01-01

    This article presents the development and psychometric analysis of the Doctoral Readiness Self-Assessment for Doctoral Study. This survey was developed as the first step of a Web-based, on-line mentoring platform for nurses who are considering a doctoral degree program. By identifying and anticipating the predictors and barriers of success in doctoral nursing education, including practical (finances, time, geographical restriction) and personal factors (motivation, attitudes, perceived ability to navigate the application process), students are guided through a self-reflective process to determine readiness. Factor analysis revealed that interest, readiness, and support represent 3 distinct factors that may be used for additional analysis to predict future enrollment in doctoral nursing degree programs. The internal reliability analysis revealed that removing 3 items from the 15-item scale increased Cronbach's alpha from 0.75 to 0.80, and these factors explained 51.25% of variance. The self-assessment results can inform faculty's work as they mentor and guide students through the application, admission, and financial support processes for doctoral study.

  2. Using an academic-community partnership model and blended learning to advance community health nursing pedagogy.

    PubMed

    Ezeonwu, Mabel; Berkowitz, Bobbie; Vlasses, Frances R

    2014-01-01

    This article describes a model of teaching community health nursing that evolved from a long-term partnership with a community with limited existing health programs. The partnership supported RN-BSN students' integration in the community and resulted in reciprocal gains for faculty, students and community members. Community clients accessed public health services as a result of the partnership. A blended learning approach that combines face-to-face interactions, service learning and online activities was utilized to enhance students' learning. Following classroom sessions, students actively participated in community-based educational process through comprehensive health needs assessments, planning and implementation of disease prevention and health promotion activities for community clients. Such active involvement in an underserved community deepened students' awareness of the fundamentals of community health practice. Students were challenged to view public health from a broader perspective while analyzing the impacts of social determinants of health on underserved populations. Through asynchronous online interactions, students synthesized classroom and community activities through critical thinking. This paper describes a model for teaching community health nursing that informs students' learning through blended learning, and meets the demands for community health nursing services delivery.

  3. Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

    PubMed Central

    Teno, Joan M.; Gozalo, Pedro; Khandelwal, Nita; Curtis, J. Randall; Meltzer, David; Engelberg, Ruth; Mor, Vincent

    2016-01-01

    IMPORTANCE Mechanical ventilation may be lifesaving, but in certain persons, such as those with advanced dementia, it may prolong patient suffering without a clear survival benefit. OBJECTIVE To describe the use and outcomes of mechanical ventilation and its association with the increasing numbers of intensive care unit (ICU) beds in the United States for patients with advanced dementia residing in a nursing home 120 days before that hospital admission. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study evaluated Medicare beneficiaries with advanced dementia hospitalized from January 1, 2000, to December 31, 2013, using the Minimum Data Set assessments linked with Medicare part A claims. A hospital fixed-effect, multivariable logistic regression model examined the effect of changes in ICU beds within individual hospitals and the likelihood of receiving mechanical ventilation, controlling for patients’ demographic characteristics, function, and comorbidities. MAIN OUTCOMES AND MEASURES Mechanical ventilation. RESULTS From 2000 to 2013, a total of 635 008 hospitalizations of 380 060 eligible patients occurred (30.5% male and 69.5% female; mean [SD] age, 84.4 [7.4] years). Use of mechanical ventilation increased from 39 per 1000 hospitalizations in 2000 to 78 per 1000 hospitalizations in 2013 (P < .001, test of linear trend). As the number of ICU beds in a hospital increased over time, patients with advanced dementia were more likely to receive mechanical ventilation (ie, adjusted odds ratio per 10 ICU bed increase, 1.06; 95% CI, 1.05–1.07). In 2013, hospitals in the top decile in the number of ICU beds were reimbursed $9611.89 per hospitalization compared with $8050.24 per hospitalization in the lower decile (P < .001) without an improvement in 1-year mortality (65.2% vs 64.6%; P = 54). CONCLUSIONS AND RELEVANCE Among hospitalized nursing home residents with advanced dementia, we found an increase in the use of mechanical ventilation over time

  4. A longitudinal analysis of the self-directed learning readiness level of nursing students enrolled in a problem-based curriculum.

    PubMed

    Kocaman, Gülseren; Dicle, Aklime; Ugur, Aysen

    2009-05-01

    Self-directed learning is an important outcome of nursing education. Although problem-based learning is believed to facilitate self-directed learning, previous studies have reported conflicting results. This longitudinal survey explored the perceived changes in self-directed learning for 4 years in a baccalaureate nursing education program with an integrated problem-based learning curriculum. Fifty of 59 students (response rate, 85%) completed the Self-Directed Learning Readiness Scale at five different time points: at the beginning of each academic year and at program completion. Scores were significantly lower during the first academic year compared with other years, and fourth-year scores were significantly higher than in previous years. Scores on the three subscales (i.e., self-management, desire for learning, and self-control) increased significantly during the 4 years of the program. These findings support self-directed learning as a maturational process. Implications for nursing faculty and curriculum development are discussed.

  5. The personal and professional impact of the future of nursing report.

    PubMed

    Chard, Robin

    2013-09-01

    Perioperative nurses can apply the four key messages outlined in the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health from personal and professional perspectives. Advocating to remove barriers to practice and educating the public about the perioperative nurse's role can help nurses practice to the full extent of their education and training. Nurses can achieve higher levels of education and training by taking advantage of new educational opportunities that offer a more seamless progression to an advanced degree. To act as full partners with other health professionals, nurses can participate in interdisciplinary teams and implement evidence-based practice, and they can contribute to effective workforce planning and policy making by helping to collect and analyze data that will improve practice environments. The key messages of the report address all nurses, whether they are direct care providers, advanced practice RNs, educators, or administrators.

  6. The initiation and administration of drugs for advanced life support by critical care nurses in the absence of a medical practitioner.

    PubMed

    Wynne, Rochelle; Lodder, Teresa; Trapani, Tony; Hanlon, Gabrielle; Cleary, Carmel

    2002-08-01

    Current legislation does not permit the administration of first line resuscitation medications by suitably qualified Division 1 registered nurses (RNs) in the absence of a medical officer. This omission by the Drugs, Poisons and Controlled Substances Act 1981 (Vic) and the Drugs, Poisons and The Controlled Substances Regulations 1995 (Vic) leaves many critical care nurses in a vulnerable legal position. The primary aim of this study was to gauge the view of critical care nurses with respect to lobbying for change to the current legislation. In addition, the study aimed to explore and describe the educational preparation, practice perceptions and experiences of RNs working in critical care regarding cardiopulmonary resuscitation and the administration of first line advanced life support (ALS) medications in the absence of a medical officer. It was anticipated that data collected would demonstrate some of the dilemmas associated with the initiation and administration of ALS medications for practising critical care nurses and could be used to inform controlling bodies in order for them to gain an appreciation of the issues facing critical care nurses during resuscitation. A mailout survey was sent to all members of the Victorian Branch of the Australian College of Critical Care Nurses (ACCCN). The results showed that the majority of nurses underwent an annual ALS assessment and had current ALS accreditation. Nurses indicated that they felt educationally prepared and were confident to manage cardiopulmonary resuscitation without a medical officer; indeed, the majority had done so. The differences in practice issues for metropolitan, regional and rural nurses were highlighted. There is therefore clear evidence to suggest that legislative amendments are appropriate and necessary, given the time critical nature of cardiopulmonary arrest. There was overwhelming support for ACCCN Vic. Ltd to lobby the Victorian government for changes to the law.

  7. Headed in the "write" direction: nursing student publication and health promotion in the community.

    PubMed

    McMillan, Libba Reed; Raines, Kimberly

    2010-07-01

    Effective writing is vital to nursing practice. As educators, we sought to incorporate a meaningful writing assignment as part of a junior-level professional development course. We used innovative methods that support the missions of higher education in general and nursing education in particular while promoting healthful living and establishing the community-as-client. In addition to fostering health education and health promotion, this writing assignment served to enhance students' writing skills and provide them with an opportunity to have their work published. The venue for publication was The Auburn Villager, a weekly local newspaper with a circulation of 6,000 within the local community in East Alabama. The writing assignment was a tremendous success on many levels. Foremost among the positive outcomes was student pride in experiencing publication of their creative work. In addition, students reported a feeling of satisfaction that the assignment had both practical and educational utility.

  8. Documentation of advance directives among home health and hospice patients: United States, 2007.

    PubMed

    Resnick, Helaine E; Hickman, Susan; Foster, Gregory L

    2012-02-01

    This report provides nationally representative data on documentation of advance directives (ADs) among home health (HH) and hospice patients. Advance directives were recorded for 29% of HH patients and 90% of hospice discharges. Among HH patients, increasing age and use of assistive devices were associated with greater odds of having an AD, while being Hispanic or black (relative to white) and enrolled in Medicaid decreased the odds of having ADs. Among hospice discharges, being enrolled in Medicare and having 4 or 5 activities of daily living (ADL) limitations were associated with higher odds of ADs while depression, use of emergency services, and being black (relative to White) were associated with lower odds. Even after adjustment for potentially confounding factors, racial differences persist in AD documentation in both care settings.

  9. Dying tax free: the modern advance directive and patients' financial values.

    PubMed

    Kirk, Timothy W; Luck, George R

    2010-03-01

    Advance directives are often used to help patients articulate their end-of-life treatment preferences and guide proxy decision makers in making health care decisions when patients cannot. This case study and commentary puts forth a situation in which a palliative care consultation team encountered a patient with an advance directive that instructed her proxy decision maker to consider estate tax implications when making end-of-life decisions. Following presentation of the case, the authors focus on two ethical issues: 1) the appropriateness of considering patients' financial goals and values in medical decision making and 2) whether certain kinds of patient values should be considered more or less relevant than others as reasons for expressed treatment preferences. Clinicians are encouraged to accept a wide range of patient values as relevant to the clinical decision-making process and to balance the influence of those values with more traditional notions of clinical harm and benefit.

  10. Future directions for career choice research in nursing: a discussion paper.

    PubMed

    Price, Sheri

    2009-02-01

    The last few decades have seen considerable changes in the characteristics of the healthcare workplace and workforce. There is a significant emphasis on recruitment and retention of healthcare providers internationally especially within the profession of Nursing, where there is a critical and growing shortage of nurses. Career choice is a critical component of recruitment and retention strategies and has significant organizational implications in regards to person-environment fit, career satisfaction and commitment. Many extant career choice theories fail to capture the challenges, complexities and uncertainties of the 21st century. Moreover, some early theories do not recognize the unique characteristics of upcoming generational cohorts and the multivariate influences on their career decisions. An extensive review and synthesis of the related literature provide the basis for a critical discussion on the adoption of new methodological approaches to exploring career choice in Nursing. The use of qualitative and mixed method approaches, a focus on generational differences and an exploration of adaptive and adjustment processes to career change provide a foundation for future career choice research and theoretical development which are reflective of the characteristics of the contemporary employee and the reality of modern healthcare organizations.

  11. [Evolution of the significance of advance directives in the ethos of medicine].

    PubMed

    Delfosse, Marie-Luce

    2008-01-01

    Patient's right to formulate advanced directives is a result of the joint evolution of laws and the medical ethos. How is this bringing together at the same time the recognization of patient autonomy and objectifs of the art of medicine? Due to the impossibility of answering the question in a general way, the issue will be studied by referring to the positions of the Belgium order of doctors.

  12. Implications for Advanced Nursing Practice in the Use of Therapeutic Touch.

    DTIC Science & Technology

    1993-01-01

    Estebany’s annual visits to the U.S. to set up temporary healing clinics with Dora Kunz; "a well known observer of paranormal healing" (Krieger, 1.975b, p. 785...terminology or one’s belief system, the four levels describe the driving factors behind any nurse-patient intervention. Therapeutic Touch 7 La g on...not. 4. Therapeutic Touch is not dependent on the recipient’s conscious belief in the method. Therapeutic Touch 15 Rocers’ Conceta Frmeor Rogers

  13. Nursing home-acquired pneumonia.

    PubMed

    El Solh, Ali A

    2009-02-01

    Nursing home-acquired pneumonia (NHAP) was first described in 1978. Since then there has been much written regarding NHAP and its management despite the lack of well-designed studies in this patient population. The most characteristic features of patients with NHAP are the atypical presentation, which may lead to delay in diagnosis and therapy. The microbial etiology of pneumonia encompasses a wide spectrum that spans microbes recovered from patients with community-acquired pneumonia to organisms considered specific only to nosocomial settings. Decision to transfer a nursing home patient to an acute care facility depends on a host of factors, which include the level of staffing available at the nursing home, patients' advance directives, and complexity of treatment. The presence of risk factors for multidrug-resistant pathogens dictates approach to therapy. Prevention remains the cornerstone of reducing the incidence of disease. Despite the advance in medical services, mortality from NHAP remains high.

  14. Consciousness in humans and non-human animals: recent advances and future directions

    PubMed Central

    Boly, Melanie; Seth, Anil K.; Wilke, Melanie; Ingmundson, Paul; Baars, Bernard; Laureys, Steven; Edelman, David B.; Tsuchiya, Naotsugu

    2013-01-01

    This joint article reflects the authors' personal views regarding noteworthy advances in the neuroscience of consciousness in the last 10 years, and suggests what we feel may be promising future directions. It is based on a small conference at the Samoset Resort in Rockport, Maine, USA, in July of 2012, organized by the Mind Science Foundation of San Antonio, Texas. Here, we summarize recent advances in our understanding of subjectivity in humans and other animals, including empirical, applied, technical, and conceptual insights. These include the evidence for the importance of fronto-parietal connectivity and of “top-down” processes, both of which enable information to travel across distant cortical areas effectively, as well as numerous dissociations between consciousness and cognitive functions, such as attention, in humans. In addition, we describe the development of mental imagery paradigms, which made it possible to identify covert awareness in non-responsive subjects. Non-human animal consciousness research has also witnessed substantial advances on the specific role of cortical areas and higher order thalamus for consciousness, thanks to important technological enhancements. In addition, much progress has been made in the understanding of non-vertebrate cognition relevant to possible conscious states. Finally, major advances have been made in theories of consciousness, and also in their comparison with the available evidence. Along with reviewing these findings, each author suggests future avenues for research in their field of investigation. PMID:24198791

  15. Nursing: Licensed Practical and Licensed Vocational Nurses

    MedlinePlus

    ... Outlook Occupational Outlook Handbook Handbook of Methods Research Papers Copyright Information Contact & Help Economic Releases Latest Releases » ... and licensed vocational nurses may advance to supervisory positions. Some LPNs and LVNs advance to other healthcare ...

  16. Research on faculty orientation programs: guidelines and directions for nurse educators.

    PubMed

    Morin, Karen H; Ashton, Kathleen C

    2004-01-01

    The objective of this study was to review the literature for the quality of evidence available regarding faculty orientation programs and to identify practice and research implications. Computerized searches in Medline, Cumulative Index to Nursing and Allied Health Literature, and Educational Resources Information Center, and references cited in articles, were the data sources reviewed. Keywords used in the search were faculty orientation, faculty development, faculty development programs, faculty mentoring, new faculty needs, nursing, teaching, and mentoring. All relevant articles published after 1980 were evaluated. Nineteen reports of research from indexed journals in English relevant to the keywords were reviewed: 14 were quantitative reports, and 5 were qualitative. Characteristics consistently present in the literature were that an orientation program takes place over a prolonged period of time, is incorporated into faculty development plans, creates or fosters an inviting environment, includes information about the tripartite role of the academician, and identifies a specific institutional resource person such as a mentor. Most research to date has been descriptive, consistent with the third level of quality of evidence (III; Marek, 1995). Faculty for whom orientation programs are offered might immerse themselves more effectively in their new environments. Mentoring relationships can ease faculty transitions.

  17. The Impact of Advanced Pharmacy Practice Experiences on Students' Readiness for Self-directed Learning

    PubMed Central

    Haines, Stuart T.; Plaza, Cecilia M.; Sturpe, Deborah A.; Williams, Greg; Rodriguez de Bittner, Magaly A.; Roffman, David S.

    2009-01-01

    Objective To evaluate the impact of advanced pharmacy practice experiences (APPEs) on doctor of pharmacy (PharmD) students' readiness for self-directed learning. Methods The Self-Directed Learning Readiness Scale (SDLRS) was administered to students prior to and after completing their APPEs. SDLRS is a validated instrument that determines the relative degree to which students have the attitudes and motivation to engage in self-directed learning. Results Seventy-seven (64%) students completed the SDLRS prior to starting their APPEs and 80 (67%) students completed the instrument after completing their APPEs. Forty-six (38%) students completed both. Prior to starting their APPEs, 74% of students scored greater than 150 on the SDLRS, indicating a high level of readiness for self-directed learning. No significant difference was found between the mean scores of students who took the SDLRS both prior to (159 ± 20) and after completing their APPEs (159 ± 24; p > 0.05). Conclusion Students at our institution appear to be ready for self-directed learning but APPEs had a minimal impact on their readiness for self-directed learning. PMID:19657498

  18. Current Directions in Family Nurse Practitioner Curricula. Proceedings of a National Conference of Representatives from Family Nurse Practitioner Programs (Chapel Hill, North Carolina, January 29-31, 1976)

    ERIC Educational Resources Information Center

    Pickard, C. Glenn, Jr., Ed.; Watkins, Julia D., Ed.

    The conference reported here was held for nurse faculty and physicians from twenty-five family nurse practitioner (FNP) programs based in twenty-one states to provide the participants with an opportunity to consider their common curriculum problems and successes in FNP education. The first half of this booklet contains five paper presentations…

  19. Graduate Education in Nursing: Issues and Future Directions. Proceedings of a Conference Sponsored by the Nursing Curriculum Project (Atlanta, Georgia, December 2-3, 1980).

    ERIC Educational Resources Information Center

    Smith, Mary Howard, Ed.

    Proceedings of a conference on graduate education in nursing, which sought to provide a forum for discussion of issues and to share the findings and experiences of the graduate demonstration projects undertaken under the aegis of the Southern Regional Education Board's Nursing Curriculum Project, are presented. Contents include: "Purposes of…

  20. Progress in the Development of Direct Osmotic Concentration Wastewater Recovery Process for Advanced Life Support Systems

    NASA Technical Reports Server (NTRS)

    Cath, Tzahi Y.; Adams, Dean V.; Childress, Amy; Gormly, Sherwin; Flynn, Michael

    2005-01-01

    Direct osmotic concentration (DOC) has been identified as a high potential technology for recycling of wastewater to drinking water in advanced life support (ALS) systems. As a result the DOC process has been selected for a NASA Rapid Technology Development Team (RTDT) effort. The existing prototype system has been developed to a Technology Readiness Level (TRL) 3. The current project focuses on advancing the development of this technology from TRL 3 to TRL 6 (appropriate for human rated testing). A new prototype of a DOC system is been designed and fabricated that addresses the deficiencies encountered during the testing of the original system and allowing the new prototype to achieve TRL 6. Background information is provided about the technologies investigated and their capabilities, results from preliminary tests, and the milestones plan and activities for the RTDT program intended to develop a second generation prototype of the DOC system.

  1. An emancipatory theory of compassion for nursing.

    PubMed

    Georges, Jane M

    2013-01-01

    The purpose of this article was to critique and synthesize the trajectory of the work of Dr Jane Georges in Advances in Nursing Science over the past decade in the development of an emancipatory theory of compassion, with implications for contemporary nursing. Specifically, this article (1) summarizes and critiques the work in each stage of its development, describing missing elements at each stage and subsequent development of ideas built upon previous work, and (2) proposes future directions for the work, including the proposal of a theory of compassion within the emancipatory paradigm to guide further scholarly inquiry in nursing.

  2. Decision making in nursing practice: a case review.

    PubMed

    Clack, Gail

    2009-06-01

    Clinical decisions and clinical judgements are important elements of nursing practice because they have a direct effect on patient care. A four-stage information processing framework was used to critique a decision to carry out chest examination and auscultation during the routine assessment of a child's asthma status. The use of this process demonstrates that nurses apply a combination of analytical and intuitive strategies when making decisions. Nurses who manage the care of patients in nurse-led clinics need to acquire advanced assessment skills to support their clinical decision making.

  3. Work satisfaction among California registered nurses: a longitudinal comparative analysis.

    PubMed

    Tellez, Michelle

    2012-01-01

    California's minimum nurse-to-patient staffing ratio law, the nation's first, was implemented in 2004. This study had two aims: (a) to evaluate the effect of the nurse-to-patient ratios law on nurse job satisfaction in order to advance the debate over the merits of nurse staffing law, and (b) to compare California nurses who were satisfied against those who were not, in order to facilitate the development targeted retention interventions based on empirical evidence. The sample's overall job satisfaction increased significantly as the years passed, suggesting the nurse-to-patient ratios law was associated with improvements in nurse satisfaction. Satisfied RNs were more likely to have a balanced and financially secure life that included a partner, children living at home, higher hourly wages, and higher income from sources other than a nursing job. Nurses working in direct patient care positions remained dissatisfied in larger proportions than those working in other types of positions, even after the nurse-to-patient ratios were implemented. More nurses are satisfied today than before the ratios; nevertheless, far too many nurses (18.5%) have job satisfaction scores that are neutral or worse.

  4. (AADSF) Advanced Automated Directional Solidification Furnace Onboard STS-87 USMP-4

    NASA Technical Reports Server (NTRS)

    1997-01-01

    The purpose of the experiments for the Advanced Automated Directional Solidification Furnace (AADSF) is to determine how gravity-driven convection affects the composition and properties of alloys (mixtures of two or more materials, usually metal). During the USMP-4 mission, the AADSF will solidify crystals of lead tin telluride and mercury cadmium telluride, alloys of compound semiconductor materials used to make infrared detectors and lasers, as experiment samples. Although these materials are used for the same type application their properties and compositional uniformity are affected differently during the solidification process.

  5. Cancer nursing in Ontario: defining nursing roles.

    PubMed

    Fitch, Margaret I; Mings, Deborah

    2003-01-01

    The delivery of cancer care in Ontario is facing unprecedented challenges. Shortages in nursing, as in all professional disciplines, are having an impact on the delivery of cancer care. Oncology nurses have a major role to play in the delivery of optimum cancer care. Oncology nursing, when adequately defined and supported, can benefit the cancer delivery system, patients, and families. A primary nursing model is seen as being key to the delivery of optimum cancer care. Primary nursing as a philosophy facilitates continuity of care, coordination of a patient's care plan, and a meaningful ongoing relationship with the patient and his/her family. Primary nursing, when delivered in the collaboration of a nurse-physician team, allows for medical resources to be used appropriately. Defined roles enable nurses to manage patients within their scope of practice in collaboration with physicians. Enacting other nursing roles, such as nurse practitioners and advanced practice nurses, can also enable the health care system to manage a broader number of patients with more complex needs. This article presents a position paper originally written as the basis for an advocacy and education initiative in Ontario. It is shared in anticipation that the work may be useful to oncology nurses in other jurisdictions in their efforts to advance oncology nursing and improvement of patient care.

  6. “Picking up the pieces”—Meanings of receiving home nursing care when being old and living with advanced cancer in a rural area

    PubMed Central

    Devik, Siri Andreassen; Hellzen, Ove; Enmarker, Ingela

    2015-01-01

    Rural home nursing care is a neglected area in the research of palliative care offered to older cancer patients. Because access to specialized services is hampered by long distances and fragmented infrastructure, palliative care is often provided through standard home nursing services and delivered by general district nurses. This study aimed to illuminate the lived experience and to interpret the meaning of receiving home nursing care when being old and living with advanced cancer in a rural area in Norway. Narrative interviews were conducted with nine older persons, and a phenomenological hermeneutic approach was used to interpret the meaning of the lived experience. The analysis revealed three themes, each with subthemes: being content with what one gets, falling into place, and losing one's place. The phrase picking up the pieces was found useful to sum up the meaning of this lived experience. The three respective themes refer to how the pieces symbolize the remaining parts of life or available services in their environment, and how the older persons may see themselves as pieces or bricks in a puzzle. A strong place attachment (physical insideness, social insideness, and autobiographical insideness) is demonstrated by the informants in this study and suggests that the rural context may provide an advantageous healthcare environment. Its potential to be a source of comfort, security, and identity concurs with cancer patients’ strong desire for being seen as unique persons. The study shows that district nurses play an essential role in the provision of palliative care for older rural patients. However, the therapeutic value of being in one's familiar landscape seems to depend on how homecare nurses manage to locate it and use it in a more or less person-centred manner. Communication skills and attentiveness to psychosocial aspects of patient care stand out as important attributes for nursing in this context. PMID:26362533

  7. The future of nursing: understanding who nurses are.

    PubMed

    Wyatt, David A

    2013-09-01

    The Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health highlights the need for more information about the nursing workforce. Without attention to the problem, OR nursing is likely to continue to experience the nursing shortage more acutely than other practice areas. By changing how they acquire and use nursing data, and by advocating for improved exchange of data between federal and state governments and nursing schools, facilities can be better prepared for future workforce challenges.

  8. Wild Orangutan Males Plan and Communicate Their Travel Direction One Day in Advance

    PubMed Central

    van Schaik, Carel P.; Damerius, Laura; Isler, Karin

    2013-01-01

    The ability to plan for the future beyond immediate needs would be adaptive to many animal species, but is widely thought to be uniquely human. Although studies in captivity have shown that great apes are capable of planning for future needs, it is unknown whether and how they use this ability in the wild. Flanged male Sumatran orangutans (Pongo abelii) emit long calls, which females use to maintain earshot associations with them. We tested whether long calls serve to communicate a male's ever-changing predominant travel direction to facilitate maintaining these associations. We found that the direction in which a flanged male emits his long calls predicts his subsequent travel direction for many hours, and that a new call indicates a change in his main travel direction. Long calls given at or near the night nest indicate travel direction better than random until late afternoon on the next day. These results show that male orangutans make their travel plans well in advance and announce them to conspecifics. We suggest that such a planning ability is likely to be adaptive for great apes, as well as in other taxa. PMID:24040357

  9. In search of an advance directive that works for end-stage renal disease patients.

    PubMed

    Bartlow, Bruce

    2006-10-01

    Although loss, disability, and death are constant possibilities for any end-stage renal disease patient, very few have planned for the last of life. Currently available Advance Directives (ADs) are refusal of specific therapies in only specific but nebulous circumstances. They fail to provide positive guidance for a patient's remaining time. Without addressing goals, quality of life, reversibility of medical problems, and desired end-of-life (EOL) care, such ADs are useless. End-stage renal disease providers are generally untrained and unsupported in offering guidance. Financial, emotional, and structural factors collude to justify ignoring EOL planning. Several alternative ADs are offered, along with a goal-directed approach to EOL counseling for patients and staff.

  10. Regulatory Advances in 11 Sub-Saharan Countries in Year 3 of the African Health Profession Regulatory Collaborative for Nurses and Midwives (ARC).

    PubMed

    Dynes, Michelle; Tison, Laura; Johnson, Carla; Verani, Andre; Zuber, Alexandra; Riley, Patricia L

    2016-01-01

    Sub-Saharan Africa carries the greatest burden of the HIV pandemic. Enhancing the supply and use of human resources through policy and regulatory reform is a key action needed to improve the quality of HIV services in this region. In year 3 of the African Health Profession Regulatory Collaborative for Nurses and Midwives (ARC), a President's Emergency Plan for AIDS Relief initiative, 11 country teams of nursing and midwifery leaders ("Quads") received small grants to carry out regulatory improvement projects. Four countries advanced a full stage on the Regulatory Function Framework (RFF), a staged capability maturity model used to evaluate progress in key regulatory functions. While the remaining countries did not advance a full stage on the RFF, important gains were noted. The year-3 evaluation highlighted limitations of the ARC evaluation strategy to capture nuanced progress and provided insight into how the RFF might be adapted for future use.

  11. The Recent Revolution in the Design and Manufacture of Cranial Implants: Modern Advancements and Future Directions

    PubMed Central

    Bonda, David J.; Manjila, Sunil; Selman, Warren R.; Dean, David

    2015-01-01

    Large format (i.e., > 25 cm2) cranioplasty is a challenging procedure not only from a cosmesis standpoint, but also in terms of ensuring that the patient's brain will be well-protected from direct trauma. Until recently, when a patient's own cranial flap was unavailable, these goals were unattainable. Recent advances in implant Computer Aided Design and 3-D printing are leveraging other advances in regenerative medicine. It is now possible to 3-D-print patient-specific implants from a variety of polymer, ceramic, or metal components. A skull template may be used to design the external shape of an implant that will become well integrated in the skull, while also providing beneficial distribution of mechanical force distribution in the event of trauma. Furthermore, an internal pore geometry can be utilized to facilitate the seeding of banked allograft cells. Implants may be cultured in a bioreactor along with recombinant growth factors to produce implants coated with bone progenitor cells and extracellular matrix that appear to the body as a graft, albeit a tissue-engineered graft. The growth factors would be left behind in the bioreactor and the graft would resorb as new host bone invades the space and is remodeled into strong bone. As we describe in this review, such advancements will lead to optimal replacement of cranial defects that are both patient-specific and regenerative. PMID:26171578

  12. Exploring direct and indirect influences of physical work environment on job satisfaction for early-career registered nurses employed in hospitals.

    PubMed

    Djukic, Maja; Kovner, Christine T; Brewer, Carol S; Fatehi, Farida; Greene, William H

    2014-08-01

    We explored direct and indirect influences of physical work environment on job satisfaction in a nationally representative sample of 1,141 early-career registered nurses. In the fully specified model, physical work environment had a non-significant direct effect on job satisfaction. The path analysis used to test multiple indirect effects showed that physical work environment had a positive indirect effect (p < .05) on job satisfaction through ten variables: negative affectivity, variety, workgroup cohesion, nurse-physician relations, quantitative workload, organizational constraints, distributive justice, promotional opportunity, local and non-local job opportunities. The findings make important contributions to the understanding of the relationship between physical work environment and job satisfaction. The results can inform health care leaders' insight about how physical work environment influences nurses' job satisfaction.

  13. The role of governance in implementing task-shifting from physicians to nurses in advanced roles in Europe, U.S., Canada, New Zealand and Australia.

    PubMed

    Maier, Claudia B

    2015-12-01

    Task-shifting from physicians to nurses is increasing worldwide; however, research on how it is governed is scarce. This international study assessed task-shifting governance models and implications on practice, based on a literature scoping review; and a survey with 93 country experts in 39 countries (response rate: 85.3%). Governance was assessed by several indicators, regulation of titles, scope of practice, prescriptive authority, and registration policies. This policy analysis focused on eleven countries with task-shifting at the Advanced Practice Nursing/Nurse Practitioner (APN/NP) level. Governance models ranged from national, decentralized to no regulation, but at the discretion of employers and settings. In countries with national or decentralized regulation, restrictive scope of practice laws were shown as barrier, up-to-date laws as enablers to advanced practice. Countries with decentralized regulation resulted in uneven levels of practice. In countries leaving governance to individual settings, practice variations existed, moreover data availability and role clarity was limited. Policy options include periodic reviews to ensure laws are up to date, minimum harmonization in decentralized contexts, harmonized educational and practice-level requirements to reduce practice variation and ensure quality. From a European Union (EU) perspective, regulation is preferred over non-regulation as a first step toward the recognition of qualifications in countries with similar levels of advanced practice. Countries early on in the process need to be aware that different governance models can influence practice.

  14. Toward Advanced Nursing Practice along with People-Centered Care Partnership Model for Sustainable Universal Health Coverage and Universal Access to Health 1

    PubMed Central

    Kamei, Tomoko; Takahashi, Keiko; Omori, Junko; Arimori, Naoko; Hishinuma, Michiko; Asahara, Kiyomi; Shimpuku, Yoko; Ohashi, Kumiko; Tashiro, Junko

    2017-01-01

    ABSTRACT Objective: this study developed a people-centered care (PCC) partnership model for the aging society to address the challenges of social changes affecting people’s health and the new role of advanced practice nurses to sustain universal health coverage. Method: a people-centered care partnership model was developed on the basis of qualitative meta-synthesis of the literature and assessment of 14 related projects. The ongoing projects resulted in individual and social transformation by improving community health literacy and behaviors using people-centered care and enhancing partnership between healthcare providers and community members through advanced practice nurses. Results: people-centered care starts when community members and healthcare providers foreground health and social issues among community members and families. This model tackles these issues, creating new values concerning health and forming a social system that improves quality of life and social support to sustain universal health care through the process of building partnership with communities. Conclusion: a PCC partnership model addresses the challenges of social changes affecting general health and the new role of advanced practice nurses in sustaining UHC. PMID:28146179

  15. [Quality of advanced practice nurse counseling in home care settings (APN-BQ): psychometric testing of the instrument].

    PubMed

    Petry, Heidi; Suter-Riederer, Susanne; Kerker-Specker, Carmen; Imhof, Lorenz

    2014-12-01

    Hintergrund: Patientenzentrierte und individuell ausgerichtete Angebote, wie die häusliche Beratung durch Pflegeexpertinnen-APN (Advanced Practice Nurses), eignen sich besonders, chronisch kranke alte Menschen in einer möglichst selbstständigen Lebensführung zu unterstützen. Methode: Um die Qualität einer patientenzentrierten Beratung zu evaluieren, wurde ein 23-Item Instrument entwickelt und seine psychometrischen Eigenschaften mit einer Stichprobe von 206 Personen, die 80 Jahre und älter waren getestet. Ziel: Ziel dieses Artikels ist es, die Entwicklung und Evaluation des APN-BQ zu beschreiben. Die psychometrische Testung des Instruments erfolgte anhand einer Hauptkomponentenanalyse mit Varimax-Rotation. Ergebnisse: Die Analyse ergab eine stabile vier Faktorenstruktur (FS = 0,91) mit 19 Items. Alle Faktoren hatten eine Faktorladung > 0,45. Die interne Konsistenz der Gesamtskala ergab einen Wert von Cronbachs alpha 0,86. Die hohe Rücklaufquote der Fragebogen und die Tatsache, dass 98,8 % der Fragen beantwortet wurden, bestätigten die Anwendungsfreundlichkeit und Akzeptanz des Instruments. Schlussfolgerungen: Das APN-BQ erwies sich als zuverlässiges und in Bezug auf Inhalt und Konstrukt valides Instrument, die Struktur-, Prozess- und Ergebnisqualität einer patientenzentrierten Beratungsintervention in der gemeindenahen Versorgung sowie das Ausmaß der Partizipation und Selbstbefähigung (Empowerment) der zu Beratenden zu messen.

  16. Interprofessional education in the clinical setting: A qualitative look at the preceptor's perspective in training advanced practice nursing students.

    PubMed

    Chen, Angel K; Rivera, Josette; Rotter, Nicole; Green, Emily; Kools, Susan

    2016-11-01

    With the shift towards interprofessional education to promote collaborative practice, clinical preceptors are increasingly working with trainees from various professions to provide patient care. It is unclear whether and how preceptors modify their existing precepting approach when working with trainees from other professions. There is little information on strategies for this type of precepting, and how preceptors may foster or impede interprofessional collaboration. The purpose of this qualitative description pilot study was to identify current methods preceptors use to teach trainees from other professions in the clinical setting, particularly advanced practice nursing and medical trainees, and to identify factors that support or impede this type of precepting. Data collected through observations and interviews were analyzed by the research team using thematic analysis procedures. Three major themes were identified: 1) a variety of teaching approaches and levels of engagement with trainees of different professions, 2) preceptor knowledge gaps related to curricula, goals, and scope of practice of trainees from other professions, and 3) administrative, structural and logistical elements that impact the success of precepting trainees from different professions in the clinical setting. This study has implications for faculty development and evaluation of current precepting practices in clinical settings.

  17. Dental Nursing in Suriname: Training and Deployment.

    ERIC Educational Resources Information Center

    Guile, E. Ernest; And Others

    1981-01-01

    A program for training dental nurses in Surinam is described whose objective is to alleviate a serious labor shortage. Its unique characteristics include an extra year of training for advanced techniques, absence of direct supervision, and acceptance by the national professional association for dentists. (MSE)

  18. The making of a nurse entrepreneur.

    PubMed

    Porter-O'Grady, T

    1998-03-01

    Nursing provides many opportunities for professional and career advancement. The entrepreneurial pathway is especially benefited by a nursing background. Focusing on the opportunities that nursing provides for the entrepreneur opens almost any door in health care.

  19. The role of advance euthanasia directives as an aid to communication and shared decision-making in dementia.

    PubMed

    Hertogh, C M P M

    2009-02-01

    Recent evaluation of the practice of euthanasia and related medical decisions at the end of life in the Netherlands has shown a slight decrease in the frequency of physician-assisted death since the enactment of the Euthanasia Law in 2002. This paper focuses on the absence of euthanasia cases concerning patients with dementia and a written advance euthanasia directive, despite the fact that the only real innovation of the Euthanasia Law consisted precisely in allowing physicians to act upon such directives. The author discusses two principal reasons for this absence. One relates to the uncertainty about whether patients with advanced dementia truly experience the suffering they formerly feared. There is reason to assume that they don't, as a consequence of psychological adaptation and progressive unawareness (anosognosia). The second, more fundamental reason touches upon the ethical relevance of shared understanding and reciprocity. The author argues that, next to autonomy and mercifulness, "reciprocity" is a condition sine qua non for euthanasia. The absence thereof in advanced dementia renders euthanasia morally inconceivable, even if there are signs of suffering and notwithstanding the presence of an advance euthanasia directive. This does not mean, however, that advance euthanasia directives of patients with dementia are worthless. They might very well have a role in the earlier stages of certain subtypes of the disease. To illustrate this point the author presents a case in which the advance directive helped to create a window of opportunity for reciprocity and shared decision-making.

  20. Advanced leading edge thermal-structure concept. Direct bond reusable surface insulation to a composite structure

    NASA Technical Reports Server (NTRS)

    Riccitiello, S. R.; Figueroa, H.; Coe, C. F.; Kuo, C. P.

    1984-01-01

    An advanced leading-edge concept was analyzed using the space shuttle leading edge system as a reference model. The comparison indicates that a direct-bond system utilizing a high temperature (2700 F) fibrous refractory composite insulation tile bonded to a high temperature (PI/graphite) composite structure can result in a weight savings of up to 800 lb. The concern that tile damage or loss during ascent would result in adverse entry aerodynamics if a leading edge tile system were used is addressed. It was found from experiment that missing tiles (as many as 22) on the leading edge would not significantly affect the basic force-and-moment aerodynamic coefficients. Additionally, this concept affords a degree of redundancy to a thermal protection system in that the base structure (being a composite material) ablates and neither melts nor burns through when subjected to entry heating in the event tiles are actually lost or damaged during ascent.

  1. Proceedings of the advanced research and technology development direct utilization, instrumentation and diagnostics contractors' review meeting

    SciTech Connect

    Geiling, D.W. ); Goldberg, P.M. )

    1990-01-01

    The 1990 Advanced Research and Technology Development (AR TD) Direct Utilization, and Instrumentation and Diagnostics Contractors Review Meeting was held September 16--18, 1990, at the Hyatt at Chatham Center in Pittsburgh, PA. The meeting was sponsored by the US Department of Energy (DOE), Office of Fossil Energy, and the Pittsburgh and Morgantown Energy Technology Centers. Each year the meeting provides a forum for the exchange of information among the DOE AR TD contractors and interested parties. This year's meeting was hosted by the Pittsburgh Energy Technology Center and was attended by 120 individuals from industry, academia, national laboratories, and other governmental agencies. Papers were presented on research addressing coal surface, science, devolatilization and combustion, ash behavior, emission controls for gases particulates, fluid bed combustion and utilization in diesels and turbines. Individual reports are processed separately for the data bases.

  2. Tuberculosis--advances in development of new drugs, treatment regimens, host-directed therapies, and biomarkers.

    PubMed

    Wallis, Robert S; Maeurer, Markus; Mwaba, Peter; Chakaya, Jeremiah; Rustomjee, Roxana; Migliori, Giovanni Battista; Marais, Ben; Schito, Marco; Churchyard, Gavin; Swaminathan, Soumya; Hoelscher, Michael; Zumla, Alimuddin

    2016-04-01

    Tuberculosis is the leading infectious cause of death worldwide, with 9·6 million cases and 1·5 million deaths reported in 2014. WHO estimates 480,000 cases of these were multidrug resistant (MDR). Less than half of patients who entered into treatment for MDR tuberculosis successfully completed that treatment, mainly due to high mortality and loss to follow-up. These in turn illustrate weaknesses in current treatment regimens and national tuberculosis programmes, coupled with operational treatment challenges. In this Review we provide an update on recent developments in the tuberculosis drug-development pipeline (including new and repurposed antimicrobials and host-directed drugs) as they are applied to new regimens to shorten and improve outcomes of tuberculosis treatment. Several new or repurposed antimicrobial drugs are in advanced trial stages for MDR tuberculosis, and two new antimicrobial drug candidates are in early-stage trials. Several trials to reduce the duration of therapy in MDR and drug-susceptible tuberculosis are ongoing. A wide range of candidate host-directed therapies are being developed to accelerate eradication of infection, prevent new drug resistance, and prevent permanent lung injury. As these drugs have been approved for other clinical indications, they are now ready for repurposing for tuberculosis in phase 2 clinical trials. We assess risks associated with evaluation of new treatment regimens, and highlight opportunities to advance tuberculosis research generally through regulatory innovation in MDR tuberculosis. Progress in tuberculosis-specific biomarkers (including culture conversion, PET and CT imaging, and gene expression profiles) can support this innovation. Several global initiatives now provide unique opportunities to tackle the tuberculosis epidemic through collaborative partnerships between high-income countries and middle-income and low-income countries for clinical trials training and research, allowing funders to

  3. Advanced direct liquefaction concepts for PETC generic units. Final report, Phase I

    SciTech Connect

    1995-03-01

    The Advanced Concepts for Direct Coal Liquefaction program was initiated by the Department of Energy in 1991 to develop technologies that could significantly reduce the cost of producing liquid fuels by the direct liquefaction of coal. The advanced 2-stage liquefaction technology that was developed at Wilsonville over the past 10 years has contributed significantly toward decreasing the cost of producing liquids from coal to about $33/bbl. It remains, however, the objective of DOE to further reduce this cost to a level more competitive with petroleum based products. This project, among others, was initiated to investigate various alternative approaches to develop technologies that might ultimately lead to a 25 % reduction in cost of product. In this project a number of novel concepts were investigated, either individually or in a coupled configuration that had the potential to contribute toward meeting the DOE goal. The concepts included mature technologies or ones closely related to them, such as coal cleaning by oil agglomeration, fluid coking and distillate hydrotreating and dewaxing. Other approaches that were either embryonic or less developed were chemical pretreatment of coal to remove oxygen, and dispersed catalyst development for application in the 2-stage liquefaction process. This report presents the results of this project. It is arranged in four sections which were prepared by participating organizations responsible for that phase of the project. A summary of the overall project and the principal results are given in this section. First, however, an overview of the process economics and the process concepts that were developed during the course of this program is presented.

  4. Degradation pathways of lamotrigine under advanced treatment by direct UV photolysis, hydroxyl radicals, and ozone.

    PubMed

    Keen, Olya S; Ferrer, Imma; Michael Thurman, E; Linden, Karl G

    2014-12-01

    Lamotrigine is recently recognized as a persistent pharmaceutical in the water environment and wastewater effluents. Its degradation was studied under UV and ozone advanced oxidation treatments with reaction kinetics of lamotrigine with ozone (≈4 M(-1)s(-1)), hydroxyl radical [(2.1 ± 0.3) × 10(9)M(-1)s(-1)] and by UV photolysis with low and medium pressure mercury vapor lamps [quantum yields ≈0 and (2.7 ± 0.4)× 10(-4) respectively] determined. All constants were measured at pH 6 and at temperature ≈20°C. The results indicate that lamotrigine is slow to respond to direct photolysis or oxidation by ozone and no attenuation of the contaminant is expected in UV or ozone disinfection applications. The compound reacts rapidly with hydroxyl radicals indicating that advanced oxidation processes would be effective for its treatment. Degradation products were identified under each treatment process using accurate mass time-of-flight spectrometry and pathways of decay were proposed. The main transformation pathways in each process were: dechlorination of the benzene ring during direct photolysis; hydroxyl group addition to the benzene ring during the reaction with hydroxyl radicals; and triazine ring opening after reaction with ozone. Different products that form in each process may be to a varying degree less environmentally stable than the parent lamotrigine. In addition, a novel method of ozone quenching without addition of salts is presented. The new quenching method would allow subsequent mass spectrometry analysis without a solid phase extraction clean-up step. The method involves raising the pH of the sample to approximately 10 for a few seconds and lowering it back and is therefore limited to applications for which temporary pH change is not expected to affect the outcome of the analysis.

  5. Early experience with digital advance care planning and directives, a novel consumer-driven program

    PubMed Central

    Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-01-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digital ACP/AD tool, to achieve proportional representation of all 50 states by population size and then reviewed their responses. The 900 participants had an average age of 50.8 years (SD = 16.6); 84% of the men and 91% of the women were in self-reported good health when signing their ADs. Among the respondents, 94% wanted their physicians to consult a supportive and palliative care team if they were seriously ill; nearly 85% preferred cessation of life-sustaining treatments during their final days; 76% preferred to spend their final days at home or in a hospice; and 70% would accept attempted cardiopulmonary resuscitation in limited circumstances. Most respondents wanted an autopsy under certain conditions, and 62% wished to donate their organs. In conclusion, analysis of early experience with this ACP/AD platform demonstrates that individuals of different ages and conditions can engage in an interrogatory process about values, develop ADs that are more nuanced than traditional paper-based ADs in reflecting those values, and easily make changes to their ADs. Online ADs have the potential to remove barriers to ACP/AD and thus further improve patient-centered end-of-life care. PMID:27365867

  6. Veterans Health Administration Office of Nursing Services exploration of positive patient care synergies fueled by consumer demand: care coordination, advanced clinic access, and patient self-management.

    PubMed

    Wertenberger, Sydney; Yerardi, Ruth; Drake, Audrey C; Parlier, Renee

    2006-01-01

    The consumers who utilize the Veterans Health Administration healthcare system are older, and most are learning to live with chronic diseases. Their desires and needs have driven changes within the Veterans Health Administration. Through patient satisfaction initiatives and other feedback sources, consumers have made it clear that they do not want to wait for their care, they want a say in what care is provided to them, and they want to remain as independent as possible. Two interdisciplinary processes/models of healthcare are being implemented on the national level to address these issues: advanced clinic access and care coordination. These programs have a synergistic relationship and are integrated with patient self-management initiatives. Positive outcomes of these programs also meet the needs of our staff. As these new processes and programs are implemented nationwide, skills of both patients and nursing staff who provide their care need to be enhanced to meet the challenges of providing nursing care now and into the 21st century. Veterans Health Administration Office of Nursing Services Strategic Planning Work Group is defining and implementing processes/programs to ensure nurses have the knowledge, information, and skills to meet these patient care demands at all levels within the organization.

  7. Advanced Practice Registered Nurses: Gateway to Screening for Bipolar Disorder in Primary Care

    PubMed Central

    Kriebel-Gasparro, Ann Marie

    2016-01-01

    Objective: The goal of this mixed methods descriptive study was to explore Advanced Practice Registered Nurses’ (APRNs’) knowledge of bipolar disorder (BPD) and their perceptions of facilitators and barriers to screening patients with known depression for BPD. Methods: A mixed method study design using surveys on BPD knowledge and screening practices as well as focus group data collection method for facilitators and barriers to screening. Results: 89 APRNs completed the survey and 12 APRNs participated in the focus groups. APRNs in any practice setting had low knowledge scores of BPD. No significant differences in screening for BPD for primary and non primary care APRNs. Qualitative findings revealed screening relates to tool availability; time, unsure of when to screen, fear of sigma, symptoms knowledge of BPD, accessible referral system, personal experiences with BPD, and therapeutic relationships with patients. Conclusion: Misdiagnosis of BPD as unipolar depression is common in primary care settings, leading to a long lag time to optimal diagnosis and treatment. The wait time to diagnosis and treatment could be reduced if APRNs in primary care settings screen patients with a diagnosis of depression by using validated screening tools. These results can inform APRN practice and further research on the effectiveness of screening for reducing the morbidity and mortality of BPDs in primary care settings; underscores the need for integration of mental health care into primary care as well as the need for more APRN education on the diagnosis and management of bipolar disorders. PMID:27347256

  8. Advanced practice registered nurse usability testing of a tailored computer-mediated health communication program.

    PubMed

    Lin, Carolyn A; Neafsey, Patricia J; Anderson, Elizabeth

    2010-01-01

    This study tested the usability of a touch-screen-enabled Personal Education Program with advanced practice RNs. The Personal Education Program is designed to enhance medication adherence and reduce adverse self-medication behaviors in older adults with hypertension. An iterative research process was used, which involved the use of (1) pretrial focus groups to guide the design of system information architecture, (2) two different cycles of think-aloud trials to test the software interface, and (3) post-trial focus groups to gather feedback on the think-aloud studies. Results from this iterative usability-testing process were used to systematically modify and improve the three Personal Education Program prototype versions-the pilot, prototype 1, and prototype 2. Findings contrasting the two separate think-aloud trials showed that APRN users rated the Personal Education Program system usability, system information, and system-use satisfaction at a moderately high level between trials. In addition, errors using the interface were reduced by 76%, and the interface time was reduced by 18.5% between the two trials. The usability-testing processes used in this study ensured an interface design adapted to APRNs' needs and preferences to allow them to effectively use the computer-mediated health-communication technology in a clinical setting.

  9. [Introduction to nursing aesthetics].

    PubMed

    Chen, Chen-Jung; Tsai, Chuan-Hsiu; Chen, Yi-Chang

    2011-04-01

    Empirical, aesthetic, ethical, and personal knowing are the four fundamental patterns of knowledge inquiry. Of these, the aesthetic knowing pattern is least discussed in nursing literature. This article discusses the definition of nursing aesthetics; its utilization in practice; and correlations between aesthetics and clinical practice. One of the advantages inherent to nursing is its ability to deliver skillful care directly to patients. Skillful performance is essential to reduce discrepancies between goals and patterns. Aesthetic nursing addresses more than the form of nursing. It further addresses the crucial elements of nursing knowledge. The science of nursing is influential in its ability to attain harmony among abundant empiric content, power of beneficence, and pleasure of aesthetic experience. In clinical practice, nurses can employ aesthetic nursing through various channels to create meaning and promote the professional image of nurses. Concepts listed in this article may be utilized in clinical supervision, practice and education.

  10. Continuing education in nursing: a concept analysis.

    PubMed

    Gallagher, Lorraine

    2007-07-01

    The importance of continuing education for nurses has been increasingly emphasized in the nursing literature since the beginning of the profession. The concept of continuing education is often used as a substitute for associated terms such as continuing professional development and lifelong learning, thus highlighting a need for its clarification. The purpose of this article is to explain and describe continuing education, in order to encourage a broader understanding of the concept among nurses. The concept analysis is directed by Rodgers' [Rodgers, B.L., 1989. Concept analysis and the development of nursing knowledge: the evolutionary cycle. Journal of Advanced Nursing 14, 330-335] 'evolutionary approach' which is viewed as an ongoing dynamic process, and one that identifies the shared meaning of concepts. Examining everyday discourse used in the nursing literature identified the critical attributes, antecedents and consequence of continuing education in nursing. As a result, the emerging attributes of the concept are synthesised into a conceptual model. The article concludes with an exploration of the application of the concept of continuing education within nursing and its implications for professional development.

  11. Advanced Insights into Functional Brain Connectivity by Combining Tensor Decomposition and Partial Directed Coherence

    PubMed Central

    Leistritz, Lutz; Witte, Herbert; Schiecke, Karin

    2015-01-01

    Quantification of functional connectivity in physiological networks is frequently performed by means of time-variant partial directed coherence (tvPDC), based on time-variant multivariate autoregressive models. The principle advantage of tvPDC lies in the combination of directionality, time variance and frequency selectivity simultaneously, offering a more differentiated view into complex brain networks. Yet the advantages specific to tvPDC also cause a large number of results, leading to serious problems in interpretability. To counter this issue, we propose the decomposition of multi-dimensional tvPDC results into a sum of rank-1 outer products. This leads to a data condensation which enables an advanced interpretation of results. Furthermore it is thereby possible to uncover inherent interaction patterns of induced neuronal subsystems by limiting the decomposition to several relevant channels, while retaining the global influence determined by the preceding multivariate AR estimation and tvPDC calculation of the entire scalp. Finally a comparison between several subjects is considerably easier, as individual tvPDC results are summarized within a comprehensive model equipped with subject-specific loading coefficients. A proof-of-principle of the approach is provided by means of simulated data; EEG data of an experiment concerning visual evoked potentials are used to demonstrate the applicability to real data. PMID:26046537

  12. Direct-execution parallel architecture for the Advanced Continuous Simulation Language (ACSL)

    SciTech Connect

    Carroll, C.C.; Owen, J.E.

    1988-05-01

    A direct-execution parallel architecture for the Advanced Continuous Simulation Language (ACSL) is presented which overcomes the traditional disadvantages of simulations executed on a digital computer. The incorporation of parallel processing allows the mapping of simulations into a digital computer to be done in the same inherently parallel manner as they are currently mapped onto an analog computer. The direct-execution format maximizes the efficiency of the executed code since the need for a high level language compiler is eliminated. Resolution is greatly increased over that which is available with an analog computer without the sacrifice in execution speed normally expected with digitial computer simulations. Although this report covers all aspects of the new architecture, key emphasis is placed on the processing element configuration and the microprogramming of the ACLS constructs. The execution times for all ACLS constructs are computed using a model of a processing element based on the AMD 29000 CPU and the AMD 29027 FPU. The increase in execution speed provided by parallel processing is exemplified by comparing the derived execution times of two ACSL programs with the execution times for the same programs executed on a similar sequential architecture.

  13. A direct-execution parallel architecture for the Advanced Continuous Simulation Language (ACSL)

    NASA Technical Reports Server (NTRS)

    Carroll, Chester C.; Owen, Jeffrey E.

    1988-01-01

    A direct-execution parallel architecture for the Advanced Continuous Simulation Language (ACSL) is presented which overcomes the traditional disadvantages of simulations executed on a digital computer. The incorporation of parallel processing allows the mapping of simulations into a digital computer to be done in the same inherently parallel manner as they are currently mapped onto an analog computer. The direct-execution format maximizes the efficiency of the executed code since the need for a high level language compiler is eliminated. Resolution is greatly increased over that which is available with an analog computer without the sacrifice in execution speed normally expected with digitial computer simulations. Although this report covers all aspects of the new architecture, key emphasis is placed on the processing element configuration and the microprogramming of the ACLS constructs. The execution times for all ACLS constructs are computed using a model of a processing element based on the AMD 29000 CPU and the AMD 29027 FPU. The increase in execution speed provided by parallel processing is exemplified by comparing the derived execution times of two ACSL programs with the execution times for the same programs executed on a similar sequential architecture.

  14. School Nurse Intention to Pursue Higher Education

    ERIC Educational Resources Information Center

    Broussard, Lisa; White, Debra

    2014-01-01

    In 2011, the Institute of Medicine recommended that 80% of the nurses possess a minimum of a bachelor of science in nursing by 2020 and double the number of doctorally prepared nurses. This has prompted a significant number of registered nurses to advance their educational level. School nurses in Louisiana are not required to have a bachelor's…

  15. An Assessment of North American Nursing.

    ERIC Educational Resources Information Center

    Commission on Graduates of Foreign Nursing Schools, Philadelphia, PA.

    This document, prepared under the auspices of the Trilateral Initiative for North American Nursing, a professional organization of nursing, examines and compares nursing standards in Canada, Mexico, and the United States. The report focuses on first-level, general nurses and advanced or specialty practice nurses, and is organized in four parts:…

  16. Recent advances in direct methanol fuel cells at Los Alamos National Laboratory

    NASA Astrophysics Data System (ADS)

    Ren, Xiaoming; Zelenay, Piotr; Thomas, Sharon; Davey, John; Gottesfeld, Shimshon

    This paper describes recent advances in the science and technology of direct methanol fuel cells (DMFCs) made at Los Alamos National Laboratory (LANL). The effort on DMFCs at LANL includes work devoted to portable power applications, funded by the Defense Advanced Research Project Agency (DARPA), and work devoted to potential transport applications, funded by the US DOE. We describe recent results with a new type of DMFC stack hardware that allows to lower the pitch per cell to 2 mm while allowing low air flow and air pressure drops. Such stack technology lends itself to both portable power and potential transport applications. Power densities of 300 W/l and 1 kW/l seem achievable under conditions applicable to portable power and transport applications, respectively. DMFC power system analysis based on the performance of this stack, under conditions applying to transport applications (joint effort with U.C. Davis), has shown that, in terms of overall system efficiency and system packaging requirements, a power source for a passenger vehicle based on a DMFC could compete favorably with a hydrogen-fueled fuel cell system, as well as with fuel cell systems based on fuel processing on board. As part of more fundamental studies performed, we describe optimization of anode catalyst layers in terms of PtRu catalyst nature, loading and catalyst layer composition and structure. We specifically show that, optimized content of recast ionic conductor added to the catalyst layer is a sensitive function of the nature of the catalyst. Other elements of membrane/electrode assembly (MEA) optimization efforts are also described, highlighting our ability to resolve, to a large degree, a well-documented problem of polymer electrolyte DMFCs, namely "methanol crossover". This was achieved by appropriate cell design, enabling fuel utilization as high as 90% in highly performing DMFCs.

  17. American Association of Nurse Anesthetists

    MedlinePlus

    ... us in Seattle on Sept. 8-12 for nurse anesthesia's premier educational, professional, and social event! Register ... on health policy research that will validate the nurse anesthesia profession and advance patient safety. 150 AANA ...

  18. Engaging Chinese American Adults in Advance Care Planning: A Community-Based, Culturally Sensitive Seminar.

    PubMed

    Lee, Mei Ching; Hinderer, Katherine A; Friedmann, Erika

    2015-08-01

    Ethnic minority groups are less engaged than Caucasian American adults in advance care planning (ACP). Knowledge deficits, language, and culture are barriers to ACP. Limited research exists on ACP and advance directives in the Chinese American adult population. Using a pre-posttest, repeated measures design, the current study explored the effectiveness of a nurseled, culturally sensitive ACP seminar for Chinese American adults on (a) knowledge, completion, and discussion of advance directives; and (b) the relationship between demographic variables, advance directive completion, and ACP discussions. A convenience sample of 72 urban, community-dwelling Chinese American adults (mean age=61 years) was included. Knowledge, advance directive completion, and ACP discussions increased significantly after attending the nurse-led seminar (p<0.01). Increased age correlated with advance directive completion and ACP discussions; female gender correlated with ACP discussions. Nursing education in a community setting increased advance directive knowledge and ACP engagement in Chinese American adults.

  19. Advanced Foreign Language Learning: A Challenge to College Programs. Issues in Language Program Direction.

    ERIC Educational Resources Information Center

    Byrnes, Heidi, Ed.; Maxim, Hiram H., Ed.

    This book includes the following chapters: "Literacy and Advanced Foreign Language Learning: Rethinking he Curriculum" (Richard G. Kern); "A Template for Advanced Learner Tasks: Staging Genre Reading and Cultural Literacy Through the Precis" (Janet Swaffar); "Fostering Advanced L2 Literacy: A Genre-Based, Cognitive…

  20. The standardization of critical care nursing education and training: strategies for advancing clinical practice in Ontario's adult ICUs.

    PubMed

    Hynes, Patricia; Pinto, Marsha; Fortier, Wendy; Bennett, Jocelyn

    2007-01-01

    In 2004/2005, the Ontario Ministry of Health and Long-Term Care (MOHLTC) launched a critical care transformation strategy with a goal to enhance service delivery through improved access, quality and system resource management. Health human resources planning was seen as essential to the success of the strategy, particularly recruitment, education/training and retention of critical care nurses. A nursing task group was invited to articulate core competencies and practice standards that can be applied across Ontario's adult ICUs and to make recommendations for implementation and the training needed to encourage compliance with the initiative. In this article, the opportunity to position nursing within the Ontario MOHLTC vision is described, as well as the work undertaken to prepare for a province-wide approach to critical care nursing education and training.

  1. Nursing and the next millennium.

    PubMed

    Huch, M H

    1995-01-01

    On March 19, 1993, in Toronto, Canada, at Discovery International, Inc.'s, Biennnial Nurse Theorist Conference, five theorists participated in a panel discussion on: caring as an essence of nursing; the value of continuing to develop nursing theory; what constitutes nursing research; the role of advanced practice nurses. The theorists were Imogene M. King, Madeleine M. Leininger, Rosemarie Rizzo Parse, Hildegard E. Peplau, and Martha E. Rogers. Marlaine C. Smith was the moderator and presented the questions to the panel.

  2. Master’s programs in advanced nursing practice: new strategies to enhance course design for subspecialty training in neonatology and pediatrics

    PubMed Central

    Morgan, Colin; Barry, Catherine; Barnes, Katie

    2012-01-01

    The advanced nurse practitioner (ANP) role first developed in the USA in the 1960s in primary care. Since then, it has evolved in many different countries and subspecialties, creating a variety of challenges for those designing and implementing master’s programs for this valuable professional group. We focus on ANPs in the neonatal and pediatric intensive care setting to illustrate the complexity of issues faced by both faculty and students in such a program. We review the impact of limited resources, faculty recruitment/accreditation, and the relationship with the medical profession in establishing a curriculum. We explore the evidence for the importance of ANP role definition, supervision, and identity among other health professionals to secure a successful role transition. We describe how recent advances in technology can be used to innovate with new styles of teaching and learning to overcome some of the difficulties in running master’s programs for small subspecialties. We illustrate, through our own experience, how a thorough assessment of the available literature can be used to innovate and develop strategies to create an individual MSc programs that are designed to meet the needs of highly specialized advanced neonatal and pediatric nursing practice. PMID:23762011

  3. Occupational health nursing and the quest for professional authority.

    PubMed

    Draper, Elaine; Ladou, Joseph; Tennenhouse, Dan J

    2011-01-01

    Occupational health nurses provide most of the in-plant health care services in U.S. industry but have dubious credentials to provide care for many of the injuries and illnesses they encounter. The nurses work directly for the employer in an atmosphere designed to control employer costs and employee benefits. Their loyalty to the company and limited autonomy make it unlikely that they will represent the workers' interests. They generally embrace any expansion of their roles within the company. However, employers and government have made no serious effort to determine whether nurses can adequately take on these new functions and advance occupational health. A nurse-directed model carries the risk that nurses who are not knowledgeable enough about the law, or are overly committed to reducing costs, may overdelegate responsibilities, thereby aiding and abetting the unlicensed practice of nursing. This overreaching is part of an ill-conceived effort to establish nursing as a profession with the greater independence, expertise, and control over training that longstanding professions such as medicine and law have achieved. An extensive literature devoted to the approval and acceptance of occupational health nursing exists, yet constructive criticism of occupational health nursing is almost nonexistent. Occupational health and safety is much too important to be largely relegated to an inadequately defined semi-profession, striving to attain higher professional status and control while lacking the expertise, power, professional standards, and autonomy required of a profession.

  4. Advancing the educational agenda.

    PubMed

    Baker, Cynthia

    2010-12-01

    This timely paper provides a thought-provoking analysis of current advanced practice nursing education in Canada. It comes at a critical juncture in the evolution of Canadian healthcare services and the redefinition of nursing roles. Increasingly, multiple sectors of society are calling for more nurses with advanced practice preparation and for a wider range of advanced practice nursing specialties. Advanced practice nurses (APNs) are being proposed as a solution to a financially overburdened national healthcare system, the increasing complexity of healthcare services, and a crisis in access to primary healthcare. Thus, governments seeking greater fiscal efficiency, medical specialists needing sophisticated collaborative support, and healthcare consumers see APNs as the way forward.

  5. Intricate decision making: ambivalences and barriers when fulfilling an advance directive

    PubMed Central

    Schröder, Lars; Hommel, Gerhard; Sahm, Stephan

    2016-01-01

    Background Despite a recent statutory ruling stating the binding nature of advance directives (ADs), only a minority of the population has signed one. Yet, a majority deem it of utmost importance to ensure their wishes are followed through in case they are no longer able to decide. The reasons for this discrepancy have not yet been investigated sufficiently. Patients and methods This article is based on a survey of patients using a well-established structured questionnaire. First, patients were asked about their attitudes with respect to six therapeutic options at the end of life: intravenous fluids, artificial feeding, antibiotics, analgesia, chemotherapy/dialysis, and artificial ventilation; and second, they were asked about the negative effects related to the idea of ADs surveying their apprehensions: coercion to fulfill an AD, dictatorial reading of what had been laid down, and abuse of ADs. Results A total of 1,260 interviewees completed the questionnaires. A significant percentage of interviewees were indecisive with respect to therapeutic options, ranging from 25% (analgesia) to 45% (artificial feeding). There was no connection to health status. Apprehensions about unwanted effects of ADs were widespread, at 51%, 35%, and 43% for coercion, dictatorial reading, and abuse, respectively. Conclusion A significant percentage of interviewees were unable to anticipate decisions about treatment options at the end of life. Apprehensions about negative adverse effects of ADs are widespread. PMID:27574407

  6. The Attitudes of Chinese Cancer Patients and Family Caregivers toward Advance Directives

    PubMed Central

    Zhang, Qiu; Xie, Chuanbo; Xie, Shanghang; Liu, Qing

    2016-01-01

    Advance directives (ADs) have been legislated in many countries to protect patient autonomy regarding medical decisions at the end of life. China is facing a serious cancer burden and cancer patients’ quality at the end of life should be a concern. However, limited studies have been conducted locally to gather information about attitudes toward ADs. The purpose of this study was to investigate the attitudes of Chinese cancer patients and family caregivers toward ADs and to explore the predictors that are associated with attitudes. The study indicated that although there was low awareness of ADs, most cancer patients and family caregivers had positive attitudes toward ADs after related information was explained to them. Participants preferred to discuss ADs with medical staff when they were diagnosed with a life-threatening disease. Preferences for refusing life-sustaining treatment and choosing Hospice-Palliative Care (HPC) at the end of life would increase the likelihood of agreeing with ADs. This suggests that some effective interventions to help participants better understand end-of-life treatments are helpful in promoting ADs. Moreover, the development of HPC would contribute to Chinese cancer patients and family caregivers agreeing with ADs. PMID:27529264

  7. Lightning Radio Source Retrieval Using Advanced Lightning Direction Finder (ALDF) Networks

    NASA Technical Reports Server (NTRS)

    Koshak, William J.; Blakeslee, Richard J.; Bailey, J. C.

    1998-01-01

    A linear algebraic solution is provided for the problem of retrieving the location and time of occurrence of lightning ground strikes from an Advanced Lightning Direction Finder (ALDF) network. The ALDF network measures field strength, magnetic bearing and arrival time of lightning radio emissions. Solutions for the plane (i.e., no Earth curvature) are provided that implement all of tile measurements mentioned above. Tests of the retrieval method are provided using computer-simulated data sets. We also introduce a quadratic planar solution that is useful when only three arrival time measurements are available. The algebra of the quadratic root results are examined in detail to clarify what portions of the analysis region lead to fundamental ambiguities in source location. Complex root results are shown to be associated with the presence of measurement errors when the lightning source lies near an outer sensor baseline of the ALDF network. In the absence of measurement errors, quadratic root degeneracy (no source location ambiguity) is shown to exist exactly on the outer sensor baselines for arbitrary non-collinear network geometries. The accuracy of the quadratic planar method is tested with computer generated data sets. The results are generally better than those obtained from the three station linear planar method when bearing errors are about 2 deg. We also note some of the advantages and disadvantages of these methods over the nonlinear method of chi(sup 2) minimization employed by the National Lightning Detection Network (NLDN) and discussed in Cummins et al.(1993, 1995, 1998).

  8. Therapeutic Rationales, Progresses, Failures, and Future Directions for Advanced Prostate Cancer

    PubMed Central

    Wadosky, Kristine M; Koochekpour, Shahriar

    2016-01-01

    Patients with localized prostate cancer (PCa) have several therapeutic options with good prognosis. However, survival of patients with high-risk, advanced PCa is significantly less than patients with early-stage, organ-confined disease. Testosterone and other androgens have been directly linked to PCa progression since 1941. In this review, we chronicle the discoveries that led to modern therapeutic strategies for PCa. Specifically highlighted is the biology of androgen receptor (AR), the nuclear receptor transcription factor largely responsible for androgen-stimulated and castrate-recurrent (CR) PCa. Current PCa treatment paradigms can be classified into three distinct but interrelated categories: targeting AR at pre-receptor, receptor, or post-receptor signaling. The continuing challenge of disease relapse as CR and/or metastatic tumors, destined to occur within three years of the initial treatment, is also discussed. We conclude that the success of PCa therapies in the future depends on targeting molecular mechanisms underlying tumor recurrence that still may affect AR at pre-receptor, receptor, and post-receptor levels. PMID:27019626

  9. Shaping end-of-life care: behavioral economics and advance directives.

    PubMed

    Halpern, Scott D

    2012-08-01

    A central but unmet challenge in health care delivery is to increase the probability that the care patients receive near the end of their life is consistent with their goals, values, and preferences. Providing patient-centered care at the end of life is challenging. In their final days, nearly a third of older Americans need critical decisions made regarding the use or nonuse of life-sustaining interventions, but the patients themselves cannot participate in those decisions. Although this observation highlights the promise of advance directives (ADs), to date ADs have not delivered on this promise. This article provides a new framework, based in behavioral economic theory, that may explain the current failures of ADs and point to potential solutions. Specifically, it discusses how five well-described cognitive biases that pervade human decision making (affective forecasting errors, optimism bias, present-biased preferences, focusing effects, and default options) may account for deficiencies in the uptake, efficacy, and patient-centeredness of ADs. The text suggests potential solutions in need of evaluation, discusses metrics for assessing these interventions' benefits, and considers alternatives to the approaches advocated.

  10. A proof-of-concept implementation of a unit-based advanced practice registered nurse (APRN) role: structural empowerment, role clarity and team effectiveness.

    PubMed

    Feistritzer, Nancye R; Jones, Pam O

    2014-03-01

    The quest for decreased cost of care and improved outcomes has created the need for highly effective clinical roles and teams. This article describes the role of a unit-based advanced practice registered nurse (APRN) within a proof-of-concept implementation of a new care delivery model, the Vanderbilt Anticipatory Care Team. Role clarity is central to both structural empowerment of the APRN and team effectiveness. A modified PeaceHealth Team Development Measure tool measured baseline role clarity as a component of overall team effectiveness. A role description for the unit-based APRN based on a comprehensive assessment of the proof-of-concept unit is provided.

  11. Nursing in Malawi: nursing theory in the movement to professionalize nursing.

    PubMed

    Bultemeier, Kaye I

    2012-04-01

    Nursing in Malawi has been predominately a technical trade and only recently has begun the transition to a profession with autonomy and advanced degree preparation. Nursing theories provide a framework for the evolution of nursing to an independent profession. Theories provide a means for the articulation of the nursing role to other members of the healthcare team including consumers. Healthcare and human needs are basic and the guidance provided by nursing theories, including Nightingale's, gives language and structure to the education of nurses as the profession moves into advanced practice in a developing country.

  12. Nurse attendee purchasing patterns.

    PubMed

    Weiss, M D; Savik, K; Kjervik, D K

    1993-01-01

    Retention of nursing professionals is crucial in responding to the increasing demand for and complexity of nursing care. Augmenting the decision-making role of nurses is one important retention-related strategy. Purchasing patterns reflect one aspect of nurses' decision-making role. National meetings provide nurses with an opportunity to investigate educational and employment options, as well as to preview technological advances in patient care products and supplies. Yet, the purchasing patterns of nurses related to the marketing of patient care supplies, or educational material at national meetings have rarely been acknowledged or researched. This study investigated the purchasing patterns of nurse attendees as revealed at a national meeting and how attendance influenced purchasing input following the meeting. The study addressed differences in purchasing patterns between specific groups of nurse attendees, as well as the relationship between meeting attendance motivators and purchasing patterns. A descriptive methodology utilizing participant observation at four national nursing meetings and mail survey in four phases was used to determine if there were: (1) identifiable purchasing patterns for nurses attending specific nursing-organization sponsored national meetings, (2) differences in purchasing patterns between nurse attendees from these meetings, (3) differences in self-reported post-meeting purchase input, and (4) relationships between meeting attendance motivators and purchasing patterns. The findings demonstrate that nurse attendee purchasing patterns can be identified and do vary among nursing groups. Nurse attendees at specialty meetings were more likely to act as specifiers, have a more dominant role in purchasing and were more likely to influence product purchases than were nurse attendees from generalist meetings. Self-reports of post-meeting purchasing input demonstrated that nurse attendees utilized information gained at national meetings in

  13. AANA journal course: update for nurse anesthetists. The SLAM Emergency Airway Flowchart: a new guide for advanced airway practitioners.

    PubMed

    Rich, James M; Mason, Andrew M; Ramsay, Michael A E

    2004-12-01

    Advanced airway practitioners in anesthesiology, emergency medicine, and prehospital care can suddenly and unexpectedly face difficult airway situations that can surface without warning during mask ventilation or tracheal intubation. Although tracheal intubation remains the "gold standard" in airway management, it is not always achievable, and, when it proves impossible, appropriate alternative interventions must be used rapidly to avoid serious morbidity or mortality. The SLAM Emergency Airway Flowchart (SEAF) is intended to prevent the 3 reported primary causes of adverse respiratory events (ie, inadequate ventilation, undetected esophageal intubation, and difficult intubation). The 5 pathways of the SEAF include primary ventilation, rapid-sequence intubation, difficult intubation, rescue ventilation, and cricothyrotomy. It is intended for use with adult patients by advanced airway practitioners competent in direct laryngoscopy, tracheal intubation, administration of airway drugs, rescue ventilation, and cricothyrotomy. The SEAF has limitations (eg, suitable only for use with adult patients, cannot be used by certain categories of rescue personnel, and depends heavily on assessment of Spo2). A unique benefit is provision of simple alternative techniques that can be used when another technique fails.

  14. Value of intensified nursing

    PubMed Central

    Frank, Wilhelm; Konta, Brigitte; Prusa, Nina; Raymann, Cornelia

    2006-01-01

    The concept "intensified nursing" is mentioned in differentiation to concepts of "nursing care" or "nursing" which intensifies resources or patient contact. Especially psychic and social needs of patients are very appreciated in nursing. A similar type of nursing is known under the concept "advanced nursing practice" (ANP) which means, that a specialised, academically trained nurse offers an extended nursing care in which a focus on the published knowledge of evidence based research is made. From the thin literature to this topic a selection of predetermined topics was analysed where at least two articles with a sufficient high methodical quality were available. The selected topic groups were: „Infant and paediatric nursing", "gerontology" and "oncology". Generally the five publications concerning infant and paediatric nursing could conclusive show a benefit of intensified nursing. Further research is still needed to prove intensified nursing care. Two publications could be found to the gerontological intensified nursing; both used an extended nursing model and an enlarged use of resources. Both studies demonstrated a measurable success in the applied parameters. Two studies also could be analysed in the oncological field in which successes were also provable by the applied parameters. The success was given especially in a higher patient satisfaction, one study showed an improved scheduling (time planning) of nurses. There was not one article concerning economic questions of intensified nursing care. It has to be taken into account that the financial resources have to be used effectively also in nursing nowadays. It has to be assumed that the costs are driven by increased use of resources. Savings can be achieved, however, in the form of avoided therapies and days in hospital by intensified nursing. The intensified nursing can be considered as similar cost-effective as conventional models of nursing. Ethically it is necessary to consider that the possibilities of

  15. Relationship between high-fidelity simulation and patient safety in prelicensure nursing education: a comprehensive review.

    PubMed

    Blum, Cynthia Ann; Parcells, Dax Andrew

    2012-08-01

    Advances in nursing simulation technology raise the question "Are educators feeling pressure to accommodate the learning styles of the techno-age studentry?" This integrative review evaluates the current quantitative evidence from preintervention-postintervention and control-experimental research studies related to the use of simulation in prelicensure nursing education directed at enhancing safety in nursing practice. A thorough review of the available literature using truncated search terms in several databases yielded 258 scholarly, peer-reviewed articles, of which 18 articles directly addressed the posed research question related to simulation and safety. Replete with student reports of simulation as an enjoyable learning activity, the literature does not yet support simulation over other approaches to the teaching-learning of safety competencies in nursing. Therefore, nurse educators must continue to select the most appropriate methods based on the specific course, student, or program type, with concentrated focus on competency-based safety education in nursing.

  16. Twelve-year results of a direct-bonded partial prosthesis in a patient with advanced periodontitis: a clinical report.

    PubMed

    Minami, Hiroyuki; Minesaki, Yoshito; Suzuki, Shiro; Tanaka, Takuo

    2012-08-01

    Prosthodontic treatment for patients with advanced periodontitis is a therapeutic challenge. A minimally invasive technique is preferred to preserve the remaining mobile abutment teeth. This report describes the initial clinical treatment and 12-year follow-up of a direct-bonded prosthesis reinforced with a cast metal framework, used as a conservative treatment option to replace periodontally involved maxillary lateral incisors.

  17. Biological assessment of bisphenol A degradation in water following direct photolysis and UV advanced oxidation.

    PubMed

    Chen, Pei-Jen; Linden, Karl G; Hinton, David E; Kashiwada, Shosaku; Rosenfeldt, Erik J; Kullman, Seth W

    2006-11-01

    Endocrine disrupting compounds (EDCs) are exogenous environmental chemicals that can interfere with normal hormone function and present a potential threat to both environmental and human health. The fate, distribution and degradation of EDCs is a subject of considerable investigation. To date, several studies have demonstrated that conventional water treatment processes are ineffective for removal of most EDCs and in some instances produce multiple unknown transformation products. In this study we have investigated the use of direct photolysis with low-pressure (LP) Hg UV lamps and UV+hydrogen peroxide (H(2)O(2)) advanced oxidation process (AOP) for the degradation of a prototypic endocrine disrupter, bisphenol A (BPA), in laboratory water. Removal rates of BPA and formation of degradation products were determined by high performance liquid chromatography (HPLC) analysis. Changes in estrogenic activity were evaluated using both in vitro yeast estrogen screen (YES) and in vivo vitellogenin (VTG) assays with Japanese medaka fish (Oryzias latipes). Our results demonstrate that UV alone did not effectively degrade BPA. However, UV in combination with H(2)O(2) significantly removed BPA parent compound and aqueous estrogenic activity in vitro and in vivo. Removal rates of in vivo estrogenic activity were significantly lower than those observed in vitro, demonstrating differential sensitivities of these bioassays and that certain UV/AOP metabolites may retain estrogenic activity. Furthermore, the UV/H(2)O(2) AOP was effective for reducing larval lethality in treated BPA solutions, suggesting BPA degradation occurred and that the degradation process did not result in the production of acutely toxic intermediates.

  18. The Prevalence and Contents of Advance Directives in Patients With Pacemakers

    PubMed Central

    Pasalic, Dario; Tajouri, Tanya H.; Ottenberg, Abigale L.; Mueller, Paul S.

    2013-01-01

    Background Little is known about the use of advance directives (ADs) in patients who have implantable cardiac pacemakers (PMs). Methods We conducted a retrospective review of the medical records of residents of Olmsted County, Minnesota, who underwent implantation of a cardiac PM at Mayo Clinic (Rochester, Minnesota) during 2006 and 2007 and determined the prevalence and contents of ADs in these patients. Results During the study period, 205 residents of Olmsted County (men, 53%) underwent PM implantation (mean age [SD] at implantation, 77 [15] years). Overall, 120 patients (59%) had ADs. Of these, 63 ADs (53%) were executed more than 12 months before and 33 (28%) were executed after PM implantation. Many patients specifically mentioned life-prolonging treatments in their ADs: cardiopulmonary resuscitation, 76 (63%); mechanical ventilation, 56 (47%); and hemodialysis, 31 (26%). Pain control was mentioned in 79 ADs (66%) and comfort measures were mentioned in 42 ADs (35%). Furthermore, the AD of many patients contained a general statement about end-of-life care (eg, no “heroic measures”). However, only 1 AD (1%) specifically addressed the end-of-life management of the PM. Conclusions More than half of the patients with PMs in our study had executed an AD, but only 1 patient specifically mentioned her PM in her AD. These results suggest that patients with PMs should be encouraged to execute ADs and, specifically address end-of-life device management in their ADs. Doing so may prevent end-of-life ethical dilemmas related to PM management. PMID:24215172

  19. Directional Limits on Persistent Gravitational Waves from Advanced LIGO's First Observing Run.

    PubMed

    Abbott, B P; Abbott, R; Abbott, T D; Abernathy, M R; Acernese, F; Ackley, K; Adams, C; Adams, T; Addesso, P; Adhikari, R X; Adya, V B; Affeldt, C; Agathos, M; Agatsuma, K; Aggarwal, N; Aguiar, O D; Aiello, L; Ain, A; Ajith, P; Allen, B; Allocca, A; Altin, P A; Ananyeva, A; Anderson, S B; Anderson, W G; Appert, S; Arai, K; Araya, M C; Areeda, J S; Arnaud, N; Arun, K G; Ascenzi, S; Ashton, G; Ast, M; Aston, S M; Astone, P; Aufmuth, P; Aulbert, C; Avila-Alvarez, A; Babak, S; Bacon, P; Bader, M K M; Baker, P T; Baldaccini, F; Ballardin, G; Ballmer, S W; Barayoga, J C; Barclay, S E; Barish, B C; Barker, D; Barone, F; Barr, B; Barsotti, L; Barsuglia, M; Barta, D; Bartlett, J; Bartos, I; Bassiri, R; Basti, A; Batch, J C; Baune, C; Bavigadda, V; Bazzan, M; Beer, C; Bejger, M; Belahcene, I; Belgin, M; Bell, A S; Berger, B K; Bergmann, G; Berry, C P L; Bersanetti, D; Bertolini, A; Betzwieser, J; Bhagwat, S; Bhandare, R; Bilenko, I A; Billingsley, G; Billman, C R; Birch, J; Birney, R; Birnholtz, O; Biscans, S; Biscoveanu, A S; Bisht, A; Bitossi, M; Biwer, C; Bizouard, M A; Blackburn, J K; Blackman, J; Blair, C D; Blair, D G; Blair, R M; Bloemen, S; Bock, O; Boer, M; Bogaert, G; Bohe, A; Bondu, F; Bonnand, R; Boom, B A; Bork, R; Boschi, V; Bose, S; Bouffanais, Y; Bozzi, A; Bradaschia, C; Brady, P R; Braginsky, V B; Branchesi, M; Brau, J E; Briant, T; Brillet, A; Brinkmann, M; Brisson, V; Brockill, P; Broida, J E; Brooks, A F; Brown, D A; Brown, D D; Brown, N M; Brunett, S; Buchanan, C C; Buikema, A; Bulik, T; Bulten, H J; Buonanno, A; Buskulic, D; Buy, C; Byer, R L; Cabero, M; Cadonati, L; Cagnoli, G; Cahillane, C; Calderón Bustillo, J; Callister, T A; Calloni, E; Camp, J B; Campbell, W; Canepa, M; Cannon, K C; Cao, H; Cao, J; Capano, C D; Capocasa, E; Carbognani, F; Caride, S; Casanueva Diaz, J; Casentini, C; Caudill, S; Cavaglià, M; Cavalier, F; Cavalieri, R; Cella, G; Cepeda, C B; Cerboni Baiardi, L; Cerretani, G; Cesarini, E; Chamberlin, S J; Chan, M; Chao, S; Charlton, P; Chassande-Mottin, E; Cheeseboro, B D; Chen, H Y; Chen, Y; Cheng, H-P; Chincarini, A; Chiummo, A; Chmiel, T; Cho, H S; Cho, M; Chow, J H; Christensen, N; Chu, Q; Chua, A J K; Chua, S; Chung, S; Ciani, G; Clara, F; Clark, J A; Cleva, F; Cocchieri, C; Coccia, E; Cohadon, P-F; Colla, A; Collette, C G; Cominsky, L; Constancio, M; Conti, L; Cooper, S J; Corbitt, T R; Cornish, N; Corsi, A; Cortese, S; Costa, C A; Coughlin, E; Coughlin, M W; Coughlin, S B; Coulon, J-P; Countryman, S T; Couvares, P; Covas, P B; Cowan, E E; Coward, D M; Cowart, M J; Coyne, D C; Coyne, R; Creighton, J D E; Creighton, T D; Cripe, J; Crowder, S G; Cullen, T J; Cumming, A; Cunningham, L; Cuoco, E; Dal Canton, T; Danilishin, S L; D'Antonio, S; Danzmann, K; Dasgupta, A; Da Silva Costa, C F; Dattilo, V; Dave, I; Davier, M; Davies, G S; Davis, D; Daw, E J; Day, B; Day, R; De, S; DeBra, D; Debreczeni, G; Degallaix, J; De Laurentis, M; Deléglise, S; Del Pozzo, W; Denker, T; Dent, T; Dergachev, V; De Rosa, R; DeRosa, R T; DeSalvo, R; Devenson, J; Devine, R C; Dhurandhar, S; Díaz, M C; Di Fiore, L; Di Giovanni, M; Di Girolamo, T; Di Lieto, A; Di Pace, S; Di Palma, I; Di Virgilio, A; Doctor, Z; Dolique, V; Donovan, F; Dooley, K L; Doravari, S; Dorrington, I; Douglas, R; Dovale Álvarez, M; Downes, T P; Drago, M; Drever, R W P; Driggers, J C; Du, Z; Ducrot, M; Dwyer, S E; Edo, T B; Edwards, M C; Effler, A; Eggenstein, H-B; Ehrens, P; Eichholz, J; Eikenberry, S S; Essick, R C; Etienne, Z; Etzel, T; Evans, M; Evans, T M; Everett, R; Factourovich, M; Fafone, V; Fair, H; Fairhurst, S; Fan, X; Farinon, S; Farr, B; Farr, W M; Fauchon-Jones, E J; Favata, M; Fays, M; Fehrmann, H; Fejer, M M; Fernández Galiana, A; Ferrante, I; Ferreira, E C; Ferrini, F; Fidecaro, F; Fiori, I; Fiorucci, D; Fisher, R P; Flaminio, R; Fletcher, M; Fong, H; Forsyth, S S; Fournier, J-D; Frasca, S; Frasconi, F; Frei, Z; Freise, A; Frey, R; Frey, V; Fries, E M; Fritschel, P; Frolov, V V; Fulda, P; Fyffe, M; Gabbard, H; Gadre, B U; Gaebel, S M; Gair, J R; Gammaitoni, L; Gaonkar, S G; Garufi, F; Gaur, G; Gayathri, V; Gehrels, N; Gemme, G; Genin, E; Gennai, A; George, J; Gergely, L; Germain, V; Ghonge, S; Ghosh, Abhirup; Ghosh, Archisman; Ghosh, S; Giaime, J A; Giardina, K D; Giazotto, A; Gill, K; Glaefke, A; Goetz, E; Goetz, R; Gondan, L; González, G; Gonzalez Castro, J M; Gopakumar, A; Gorodetsky, M L; Gossan, S E; Gosselin, M; Gouaty, R; Grado, A; Graef, C; Granata, M; Grant, A; Gras, S; Gray, C; Greco, G; Green, A C; Groot, P; Grote, H; Grunewald, S; Guidi, G M; Guo, X; Gupta, A; Gupta, M K; Gushwa, K E; Gustafson, E K; Gustafson, R; Hacker, J J; Hall, B R; Hall, E D; Hammond, G; Haney, M; Hanke, M M; Hanks, J; Hanna, C; Hannam, M D; Hanson, J; Hardwick, T; Harms, J; Harry, G M; Harry, I W; Hart, M J; Hartman, M T; Haster, C-J; Haughian, K; Healy, J; Heidmann, A; Heintze, M C; Heitmann, H; Hello, P; Hemming, G; Hendry, M; Heng, I S; Hennig, J; Henry, J; Heptonstall, A W; Heurs, M; Hild, S; Hoak, D; Hofman, D; Holt, K; Holz, D E; Hopkins, P; Hough, J; Houston, E A; Howell, E J; Hu, Y M; Huerta, E A; Huet, D; Hughey, B; Husa, S; Huttner, S H; Huynh-Dinh, T; Indik, N; Ingram, D R; Inta, R; Isa, H N; Isac, J-M; Isi, M; Isogai, T; Iyer, B R; Izumi, K; Jacqmin, T; Jani, K; Jaranowski, P; Jawahar, S; Jiménez-Forteza, F; Johnson, W W; Jones, D I; Jones, R; Jonker, R J G; Ju, L; Junker, J; Kalaghatgi, C V; Kalogera, V; Kandhasamy, S; Kang, G; Kanner, J B; Karki, S; Karvinen, K S; Kasprzack, M; Katsavounidis, E; Katzman, W; Kaufer, S; Kaur, T; Kawabe, K; Kéfélian, F; Keitel, D; Kelley, D B; Kennedy, R; Key, J S; Khalili, F Y; Khan, I; Khan, S; Khan, Z; Khazanov, E A; Kijbunchoo, N; Kim, Chunglee; Kim, J C; Kim, Whansun; Kim, W; Kim, Y-M; Kimbrell, S J; King, E J; King, P J; Kirchhoff, R; Kissel, J S; Klein, B; Kleybolte, L; Klimenko, S; Koch, P; Koehlenbeck, S M; Koley, S; Kondrashov, V; Kontos, A; Korobko, M; Korth, W Z; Kowalska, I; Kozak, D B; Krämer, C; Kringel, V; Królak, A; Kuehn, G; Kumar, P; Kumar, R; Kuo, L; Kutynia, A; Lackey, B D; Landry, M; Lang, R N; Lange, J; Lantz, B; Lanza, R K; Lartaux-Vollard, A; Lasky, P D; Laxen, M; Lazzarini, A; Lazzaro, C; Leaci, P; Leavey, S; Lebigot, E O; Lee, C H; Lee, H K; Lee, H M; Lee, K; Lehmann, J; Lenon, A; Leonardi, M; Leong, J R; Leroy, N; Letendre, N; Levin, Y; Li, T G F; Libson, A; Littenberg, T B; Liu, J; Lockerbie, N A; Lombardi, A L; London, L T; Lord, J E; Lorenzini, M; Loriette, V; Lormand, M; Losurdo, G; Lough, J D; Lousto, C O; Lovelace, G; Lück, H; Lundgren, A P; Lynch, R; Ma, Y; Macfoy, S; Machenschalk, B; MacInnis, M; Macleod, D M; Magaña-Sandoval, F; Majorana, E; Maksimovic, I; Malvezzi, V; Man, N; Mandic, V; Mangano, V; Mansell, G L; Manske, M; Mantovani, M; Marchesoni, F; Marion, F; Márka, S; Márka, Z; Markosyan, A S; Maros, E; Martelli, F; Martellini, L; Martin, I W; Martynov, D V; Mason, K; Masserot, A; Massinger, T J; Masso-Reid, M; Mastrogiovanni, S; Matas, A; Matichard, F; Matone, L; Mavalvala, N; Mazumder, N; McCarthy, R; McClelland, D E; McCormick, S; McGrath, C; McGuire, S C; McIntyre, G; McIver, J; McManus, D J; McRae, T; McWilliams, S T; Meacher, D; Meadors, G D; Meidam, J; Melatos, A; Mendell, G; Mendoza-Gandara, D; Mercer, R A; Merilh, E L; Merzougui, M; Meshkov, S; Messenger, C; Messick, C; Metzdorff, R; Meyers, P M; Mezzani, F; Miao, H; Michel, C; Middleton, H; Mikhailov, E E; Milano, L; Miller, A L; Miller, A; Miller, B B; Miller, J; Millhouse, M; Minenkov, Y; Ming, J; Mirshekari, S; Mishra, C; Mitra, S; Mitrofanov, V P; Mitselmakher, G; Mittleman, R; Moggi, A; Mohan, M; Mohapatra, S R P; Montani, M; Moore, B C; Moore, C J; Moraru, D; Moreno, G; Morriss, S R; Mours, B; Mow-Lowry, C M; Mueller, G; Muir, A W; Mukherjee, Arunava; Mukherjee, D; Mukherjee, S; Mukund, N; Mullavey, A; Munch, J; Muniz, E A M; Murray, P G; Mytidis, A; Napier, K; Nardecchia, I; Naticchioni, L; Nelemans, G; Nelson, T J N; Neri, M; Nery, M; Neunzert, A; Newport, J M; Newton, G; Nguyen, T T; Nielsen, A B; Nissanke, S; Nitz, A; Noack, A; Nocera, F; Nolting, D; Normandin, M E N; Nuttall, L K; Oberling, J; Ochsner, E; Oelker, E; Ogin, G H; Oh, J J; Oh, S H; Ohme, F; Oliver, M; Oppermann, P; Oram, Richard J; O'Reilly, B; O'Shaughnessy, R; Ottaway, D J; Overmier, H; Owen, B J; Pace, A E; Page, J; Pai, A; Pai, S A; Palamos, J R; Palashov, O; Palomba, C; Pal-Singh, A; Pan, H; Pankow, C; Pannarale, F; Pant, B C; Paoletti, F; Paoli, A; Papa, M A; Paris, H R; Parker, W; Pascucci, D; Pasqualetti, A; Passaquieti, R; Passuello, D; Patricelli, B; Pearlstone, B L; Pedraza, M; Pedurand, R; Pekowsky, L; Pele, A; Penn, S; Perez, C J; Perreca, A; Perri, L M; Pfeiffer, H P; Phelps, M; Piccinni, O J; Pichot, M; Piergiovanni, F; Pierro, V; Pillant, G; Pinard, L; Pinto, I M; Pitkin, M; Poe, M; Poggiani, R; Popolizio, P; Post, A; Powell, J; Prasad, J; Pratt, J W W; Predoi, V; Prestegard, T; Prijatelj, M; Principe, M; Privitera, S; Prodi, G A; Prokhorov, L G; Puncken, O; Punturo, M; Puppo, P; Pürrer, M; Qi, H; Qin, J; Qiu, S; Quetschke, V; Quintero, E A; Quitzow-James, R; Raab, F J; Rabeling, D S; Radkins, H; Raffai, P; Raja, S; Rajan, C; Rakhmanov, M; Rapagnani, P; Raymond, V; Razzano, M; Re, V; Read, J; Regimbau, T; Rei, L; Reid, S; Reitze, D H; Rew, H; Reyes, S D; Rhoades, E; Ricci, F; Riles, K; Rizzo, M; Robertson, N A; Robie, R; Robinet, F; Rocchi, A; Rolland, L; Rollins, J G; Roma, V J; Romano, J D; Romano, R; Romie, J H; Rosińska, D; Rowan, S; Rüdiger, A; Ruggi, P; Ryan, K; Sachdev, S; Sadecki, T; Sadeghian, L; Sakellariadou, M; Salconi, L; Saleem, M; Salemi, F; Samajdar, A; Sammut, L; Sampson, L M; Sanchez, E J; Sandberg, V; Sanders, J R; Sassolas, B; Sathyaprakash, B S; Saulson, P R; Sauter, O; Savage, R L; Sawadsky, A; Schale, P; Scheuer, J; Schlassa, S; Schmidt, E; Schmidt, J; Schmidt, P; Schnabel, R; Schofield, R M S; Schönbeck, A; Schreiber, E; Schuette, D; Schutz, B F; Schwalbe, S G; Scott, J; Scott, S M; Sellers, D; Sengupta, A S; Sentenac, D; Sequino, V; Sergeev, A; Setyawati, Y; Shaddock, D A; Shaffer, T J; Shahriar, M S; Shapiro, B; Shawhan, P; Sheperd, A; Shoemaker, D H; Shoemaker, D M; Siellez, K; Siemens, X; Sieniawska, M; Sigg, D; Silva, A D; Singer, A; Singer, L P; Singh, A; Singh, R; Singhal, A; Sintes, A M; Slagmolen, B J J; Smith, B; Smith, J R; Smith, R J E; Son, E J; Sorazu, B; Sorrentino, F; Souradeep, T; Spencer, A P; Srivastava, A K; Staley, A; Steinke, M; Steinlechner, J; Steinlechner, S; Steinmeyer, D; Stephens, B C; Stevenson, S P; Stone, R; Strain, K A; Straniero, N; Stratta, G; Strigin, S E; Sturani, R; Stuver, A L; Summerscales, T Z; Sun, L; Sunil, S; Sutton, P J; Swinkels, B L; Szczepańczyk, M J; Tacca, M; Talukder, D; Tanner, D B; Tao, D; Tápai, M; Taracchini, A; Taylor, R; Theeg, T; Thomas, E G; Thomas, M; Thomas, P; Thorne, K A; Thrane, E; Tippens, T; Tiwari, S; Tiwari, V; Tokmakov, K V; Toland, K; Tomlinson, C; Tonelli, M; Tornasi, Z; Torrie, C I; Töyrä, D; Travasso, F; Traylor, G; Trifirò, D; Trinastic, J; Tringali, M C; Trozzo, L; Tse, M; Tso, R; Turconi, M; Tuyenbayev, D; Ugolini, D; Unnikrishnan, C S; Urban, A L; Usman, S A; Vahlbruch, H; Vajente, G; Valdes, G; van Bakel, N; van Beuzekom, M; van den Brand, J F J; Van Den Broeck, C; Vander-Hyde, D C; van der Schaaf, L; van Heijningen, J V; van Veggel, A A; Vardaro, M; Varma, V; Vass, S; Vasúth, M; Vecchio, A; Vedovato, G; Veitch, J; Veitch, P J; Venkateswara, K; Venugopalan, G; Verkindt, D; Vetrano, F; Viceré, A; Viets, A D; Vinciguerra, S; Vine, D J; Vinet, J-Y; Vitale, S; Vo, T; Vocca, H; Vorvick, C; Voss, D V; Vousden, W D; Vyatchanin, S P; Wade, A R; Wade, L E; Wade, M; Walker, M; Wallace, L; Walsh, S; Wang, G; Wang, H; Wang, M; Wang, Y; Ward, R L; Warner, J; Was, M; Watchi, J; Weaver, B; Wei, L-W; Weinert, M; Weinstein, A J; Weiss, R; Wen, L; Weßels, P; Westphal, T; Wette, K; Whelan, J T; Whiting, B F; Whittle, C; Williams, D; Williams, R D; Williamson, A R; Willis, J L; Willke, B; Wimmer, M H; Winkler, W; Wipf, C C; Wittel, H; Woan, G; Woehler, J; Worden, J; Wright, J L; Wu, D S; Wu, G; Yam, W; Yamamoto, H; Yancey, C C; Yap, M J; Yu, Hang; Yu, Haocun; Yvert, M; Zadrożny, A; Zangrando, L; Zanolin, M; Zendri, J-P; Zevin, M; Zhang, L; Zhang, M; Zhang, T; Zhang, Y; Zhao, C; Zhou, M; Zhou, Z; Zhu, S J; Zhu, X J; Zucker, M E; Zweizig, J

    2017-03-24

    We employ gravitational-wave radiometry to map the stochastic gravitational wave background expected from a variety of contributing mechanisms and test the assumption of isotropy using data from the Advanced Laser Interferometer Gravitational Wave Observatory's (aLIGO) first observing run. We also search for persistent gravitational waves from point sources with only minimal assumptions over the 20-1726 Hz frequency band. Finding no evidence of gravitational waves from either point sources or a stochastic background, we set limits at 90% confidence. For broadband point sources, we report upper limits on the gravitational wave energy flux per unit frequency in the range F_{α,Θ}(f)<(0.1-56)×10^{-8}    erg cm^{-2} s^{-1} Hz^{-1}(f/25  Hz)^{α-1} depending on the sky location Θ and the spectral power index α. For extended sources, we report upper limits on the fractional gravitational wave energy density required to close the Universe of Ω(f,Θ)<(0.39-7.6)×10^{-8}  sr^{-1}(f/25  Hz)^{α} depending on Θ and α. Directed searches for narrowband gravitational waves from astrophysically interesting objects (Scorpius X-1, Supernova 1987 A, and the Galactic Center) yield median frequency-dependent limits on strain amplitude of h_{0}<(6.7,5.5,  and  7.0)×10^{-25}, respectively, at the most sensitive detector frequencies between 130-175 Hz. This represents a mean improvement of a factor of 2 across the band compared to previous searches of this kind for these sky locations, considering the different quantities of strain constrained in each case.

  20. Physical and chemical effects of direct aqueous advanced oxidation processing on green sand foundry mold materials

    NASA Astrophysics Data System (ADS)

    Clobes, Jason Kenneth

    Iron foundries using the common green sand molding process have increasingly been incorporating aqueous advanced oxidation (AO) systems to reduce the consumption of sand system bentonite clay and coal raw materials by and to decrease their volatile organic compound (VOC) emissions. These AO systems typically use a combination of sonication, ozone aeration, and hydrogen peroxide to treat and recycle slurries of sand system baghouse dust, which is rich in clay and coal. While the overall effects of AO on raw material consumption and organic emissions are known, the mechanisms behind these effects are not well understood. This research examined the effects of bench-scale direct aqueous AO processing on green sand mold materials at the micro level. Bench-scale AO processing, including acoustic sonication, ozone/oxygen aeration, and hydrogen peroxide dramatically decreased the particle sizes of both western bentonite and foundry sand system baghouse dust. Bench-scale AO processing was shown to effectively separate the clay material from the larger silica and coal particles and to extensively break up the larger clay agglomerates. The acoustic sonication component of AO processing was the key contributor to enhanced clay recovery. Acoustic sonication alone was slightly more effective than combined component AO in reducing the particle sizes of the baghouse dust and in the recovery of clay yields in the supernatant during sedimentation experiments. Sedimentation separation results correlated well with the increase in small particle concentrations due to AO processing. Clay suspension viscosity decreased with AO processing due to enhanced dispersion of the particles. X-ray diffraction of freeze-dried baghouse dust indicated that AO processing does not rehydrate calcined montmorillonite and does not increase the level of interlayer water hydration in the dry clays. Zeta potential measurements indicated that AO processing also does not produce any large changes in the

  1. Directional Limits on Persistent Gravitational Waves from Advanced LIGO's First Observing Run

    NASA Astrophysics Data System (ADS)

    Abbott, B. P.; Abbott, R.; Abbott, T. D.; Abernathy, M. R.; Acernese, F.; Ackley, K.; Adams, C.; Adams, T.; Addesso, P.; Adhikari, R. X.; Adya, V. B.; Affeldt, C.; Agathos, M.; Agatsuma, K.; Aggarwal, N.; Aguiar, O. D.; Aiello, L.; Ain, A.; Ajith, P.; Allen, B.; Allocca, A.; Altin, P. A.; Ananyeva, A.; Anderson, S. B.; Anderson, W. G.; Appert, S.; Arai, K.; Araya, M. C.; Areeda, J. S.; Arnaud, N.; Arun, K. G.; Ascenzi, S.; Ashton, G.; Ast, M.; Aston, S. M.; Astone, P.; Aufmuth, P.; Aulbert, C.; Avila-Alvarez, A.; Babak, S.; Bacon, P.; Bader, M. K. M.; Baker, P. T.; Baldaccini, F.; Ballardin, G.; Ballmer, S. W.; Barayoga, J. C.; Barclay, S. E.; Barish, B. C.; Barker, D.; Barone, F.; Barr, B.; Barsotti, L.; Barsuglia, M.; Barta, D.; Bartlett, J.; Bartos, I.; Bassiri, R.; Basti, A.; Batch, J. C.; Baune, C.; Bavigadda, V.; Bazzan, M.; Beer, C.; Bejger, M.; Belahcene, I.; Belgin, M.; Bell, A. S.; Berger, B. K.; Bergmann, G.; Berry, C. P. L.; Bersanetti, D.; Bertolini, A.; Betzwieser, J.; Bhagwat, S.; Bhandare, R.; Bilenko, I. A.; Billingsley, G.; Billman, C. R.; Birch, J.; Birney, R.; Birnholtz, O.; Biscans, S.; Biscoveanu, A. S.; Bisht, A.; Bitossi, M.; Biwer, C.; Bizouard, M. A.; Blackburn, J. K.; Blackman, J.; Blair, C. D.; Blair, D. G.; Blair, R. M.; Bloemen, S.; Bock, O.; Boer, M.; Bogaert, G.; Bohe, A.; Bondu, F.; Bonnand, R.; Boom, B. A.; Bork, R.; Boschi, V.; Bose, S.; Bouffanais, Y.; Bozzi, A.; Bradaschia, C.; Brady, P. R.; Braginsky, V. B.; Branchesi, M.; Brau, J. E.; Briant, T.; Brillet, A.; Brinkmann, M.; Brisson, V.; Brockill, P.; Broida, J. E.; Brooks, A. F.; Brown, D. A.; Brown, D. D.; Brown, N. M.; Brunett, S.; Buchanan, C. C.; Buikema, A.; Bulik, T.; Bulten, H. J.; Buonanno, A.; Buskulic, D.; Buy, C.; Byer, R. L.; Cabero, M.; Cadonati, L.; Cagnoli, G.; Cahillane, C.; Calderón Bustillo, J.; Callister, T. A.; Calloni, E.; Camp, J. B.; Campbell, W.; Canepa, M.; Cannon, K. C.; Cao, H.; Cao, J.; Capano, C. D.; Capocasa, E.; Carbognani, F.; Caride, S.; Casanueva Diaz, J.; Casentini, C.; Caudill, S.; Cavaglià, M.; Cavalier, F.; Cavalieri, R.; Cella, G.; Cepeda, C. B.; Cerboni Baiardi, L.; Cerretani, G.; Cesarini, E.; Chamberlin, S. J.; Chan, M.; Chao, S.; Charlton, P.; Chassande-Mottin, E.; Cheeseboro, B. D.; Chen, H. Y.; Chen, Y.; Cheng, H.-P.; Chincarini, A.; Chiummo, A.; Chmiel, T.; Cho, H. S.; Cho, M.; Chow, J. H.; Christensen, N.; Chu, Q.; Chua, A. J. K.; Chua, S.; Chung, S.; Ciani, G.; Clara, F.; Clark, J. A.; Cleva, F.; Cocchieri, C.; Coccia, E.; Cohadon, P.-F.; Colla, A.; Collette, C. G.; Cominsky, L.; Constancio, M.; Conti, L.; Cooper, S. J.; Corbitt, T. R.; Cornish, N.; Corsi, A.; Cortese, S.; Costa, C. A.; Coughlin, E.; Coughlin, M. W.; Coughlin, S. B.; Coulon, J.-P.; Countryman, S. T.; Couvares, P.; Covas, P. B.; Cowan, E. E.; Coward, D. M.; Cowart, M. J.; Coyne, D. C.; Coyne, R.; Creighton, J. D. E.; Creighton, T. D.; Cripe, J.; Crowder, S. G.; Cullen, T. J.; Cumming, A.; Cunningham, L.; Cuoco, E.; Dal Canton, T.; Danilishin, S. L.; D'Antonio, S.; Danzmann, K.; Dasgupta, A.; Da Silva Costa, C. F.; Dattilo, V.; Dave, I.; Davier, M.; Davies, G. S.; Davis, D.; Daw, E. J.; Day, B.; Day, R.; De, S.; DeBra, D.; Debreczeni, G.; Degallaix, J.; De Laurentis, M.; Deléglise, S.; Del Pozzo, W.; Denker, T.; Dent, T.; Dergachev, V.; De Rosa, R.; DeRosa, R. T.; DeSalvo, R.; Devenson, J.; Devine, R. C.; Dhurandhar, S.; Díaz, M. C.; Di Fiore, L.; Di Giovanni, M.; Di Girolamo, T.; Di Lieto, A.; Di Pace, S.; Di Palma, I.; Di Virgilio, A.; Doctor, Z.; Dolique, V.; Donovan, F.; Dooley, K. L.; Doravari, S.; Dorrington, I.; Douglas, R.; Dovale Álvarez, M.; Downes, T. P.; Drago, M.; Drever, R. W. P.; Driggers, J. C.; Du, Z.; Ducrot, M.; Dwyer, S. E.; Edo, T. B.; Edwards, M. C.; Effler, A.; Eggenstein, H.-B.; Ehrens, P.; Eichholz, J.; Eikenberry, S. S.; Essick, R. C.; Etienne, Z.; Etzel, T.; Evans, M.; Evans, T. M.; Everett, R.; Factourovich, M.; Fafone, V.; Fair, H.; Fairhurst, S.; Fan, X.; Farinon, S.; Farr, B.; Farr, W. M.; Fauchon-Jones, E. J.; Favata, M.; Fays, M.; Fehrmann, H.; Fejer, M. M.; Fernández Galiana, A.; Ferrante, I.; Ferreira, E. C.; Ferrini, F.; Fidecaro, F.; Fiori, I.; Fiorucci, D.; Fisher, R. P.; Flaminio, R.; Fletcher, M.; Fong, H.; Forsyth, S. S.; Fournier, J.-D.; Frasca, S.; Frasconi, F.; Frei, Z.; Freise, A.; Frey, R.; Frey, V.; Fries, E. M.; Fritschel, P.; Frolov, V. V.; Fulda, P.; Fyffe, M.; Gabbard, H.; Gadre, B. U.; Gaebel, S. M.; Gair, J. R.; Gammaitoni, L.; Gaonkar, S. G.; Garufi, F.; Gaur, G.; Gayathri, V.; Gehrels, N.; Gemme, G.; Genin, E.; Gennai, A.; George, J.; Gergely, L.; Germain, V.; Ghonge, S.; Ghosh, Abhirup; Ghosh, Archisman; Ghosh, S.; Giaime, J. A.; Giardina, K. D.; Giazotto, A.; Gill, K.; Glaefke, A.; Goetz, E.; Goetz, R.; Gondan, L.; González, G.; Gonzalez Castro, J. M.; Gopakumar, A.; Gorodetsky, M. L.; Gossan, S. E.; Gosselin, M.; Gouaty, R.; Grado, A.; Graef, C.; Granata, M.; Grant, A.; Gras, S.; Gray, C.; Greco, G.; Green, A. C.; Groot, P.; Grote, H.; Grunewald, S.; Guidi, G. M.; Guo, X.; Gupta, A.; Gupta, M. K.; Gushwa, K. E.; Gustafson, E. K.; Gustafson, R.; Hacker, J. J.; Hall, B. R.; Hall, E. D.; Hammond, G.; Haney, M.; Hanke, M. M.; Hanks, J.; Hanna, C.; Hannam, M. D.; Hanson, J.; Hardwick, T.; Harms, J.; Harry, G. M.; Harry, I. W.; Hart, M. J.; Hartman, M. T.; Haster, C.-J.; Haughian, K.; Healy, J.; Heidmann, A.; Heintze, M. C.; Heitmann, H.; Hello, P.; Hemming, G.; Hendry, M.; Heng, I. S.; Hennig, J.; Henry, J.; Heptonstall, A. W.; Heurs, M.; Hild, S.; Hoak, D.; Hofman, D.; Holt, K.; Holz, D. E.; Hopkins, P.; Hough, J.; Houston, E. A.; Howell, E. J.; Hu, Y. M.; Huerta, E. A.; Huet, D.; Hughey, B.; Husa, S.; Huttner, S. H.; Huynh-Dinh, T.; Indik, N.; Ingram, D. R.; Inta, R.; Isa, H. N.; Isac, J.-M.; Isi, M.; Isogai, T.; Iyer, B. R.; Izumi, K.; Jacqmin, T.; Jani, K.; Jaranowski, P.; Jawahar, S.; Jiménez-Forteza, F.; Johnson, W. W.; Jones, D. I.; Jones, R.; Jonker, R. J. G.; Ju, L.; Junker, J.; Kalaghatgi, C. V.; Kalogera, V.; Kandhasamy, S.; Kang, G.; Kanner, J. B.; Karki, S.; Karvinen, K. S.; Kasprzack, M.; Katsavounidis, E.; Katzman, W.; Kaufer, S.; Kaur, T.; Kawabe, K.; Kéfélian, F.; Keitel, D.; Kelley, D. B.; Kennedy, R.; Key, J. S.; Khalili, F. Y.; Khan, I.; Khan, S.; Khan, Z.; Khazanov, E. A.; Kijbunchoo, N.; Kim, Chunglee; Kim, J. C.; Kim, Whansun; Kim, W.; Kim, Y.-M.; Kimbrell, S. J.; King, E. J.; King, P. J.; Kirchhoff, R.; Kissel, J. S.; Klein, B.; Kleybolte, L.; Klimenko, S.; Koch, P.; Koehlenbeck, S. M.; Koley, S.; Kondrashov, V.; Kontos, A.; Korobko, M.; Korth, W. Z.; Kowalska, I.; Kozak, D. B.; Krämer, C.; Kringel, V.; Królak, A.; Kuehn, G.; Kumar, P.; Kumar, R.; Kuo, L.; Kutynia, A.; Lackey, B. D.; Landry, M.; Lang, R. N.; Lange, J.; Lantz, B.; Lanza, R. K.; Lartaux-Vollard, A.; Lasky, P. D.; Laxen, M.; Lazzarini, A.; Lazzaro, C.; Leaci, P.; Leavey, S.; Lebigot, E. O.; Lee, C. H.; Lee, H. K.; Lee, H. M.; Lee, K.; Lehmann, J.; Lenon, A.; Leonardi, M.; Leong, J. R.; Leroy, N.; Letendre, N.; Levin, Y.; Li, T. G. F.; Libson, A.; Littenberg, T. B.; Liu, J.; Lockerbie, N. A.; Lombardi, A. L.; London, L. T.; Lord, J. E.; Lorenzini, M.; Loriette, V.; Lormand, M.; Losurdo, G.; Lough, J. D.; Lousto, C. O.; Lovelace, G.; Lück, H.; Lundgren, A. P.; Lynch, R.; Ma, Y.; Macfoy, S.; Machenschalk, B.; MacInnis, M.; Macleod, D. M.; Magaña-Sandoval, F.; Majorana, E.; Maksimovic, I.; Malvezzi, V.; Man, N.; Mandic, V.; Mangano, V.; Mansell, G. L.; Manske, M.; Mantovani, M.; Marchesoni, F.; Marion, F.; Márka, S.; Márka, Z.; Markosyan, A. S.; Maros, E.; Martelli, F.; Martellini, L.; Martin, I. W.; Martynov, D. V.; Mason, K.; Masserot, A.; Massinger, T. J.; Masso-Reid, M.; Mastrogiovanni, S.; Matas, A.; Matichard, F.; Matone, L.; Mavalvala, N.; Mazumder, N.; McCarthy, R.; McClelland, D. E.; McCormick, S.; McGrath, C.; McGuire, S. C.; McIntyre, G.; McIver, J.; McManus, D. J.; McRae, T.; McWilliams, S. T.; Meacher, D.; Meadors, G. D.; Meidam, J.; Melatos, A.; Mendell, G.; Mendoza-Gandara, D.; Mercer, R. A.; Merilh, E. L.; Merzougui, M.; Meshkov, S.; Messenger, C.; Messick, C.; Metzdorff, R.; Meyers, P. M.; Mezzani, F.; Miao, H.; Michel, C.; Middleton, H.; Mikhailov, E. E.; Milano, L.; Miller, A. L.; Miller, A.; Miller, B. B.; Miller, J.; Millhouse, M.; Minenkov, Y.; Ming, J.; Mirshekari, S.; Mishra, C.; Mitra, S.; Mitrofanov, V. P.; Mitselmakher, G.; Mittleman, R.; Moggi, A.; Mohan, M.; Mohapatra, S. R. P.; Montani, M.; Moore, B. C.; Moore, C. J.; Moraru, D.; Moreno, G.; Morriss, S. R.; Mours, B.; Mow-Lowry, C. M.; Mueller, G.; Muir, A. W.; Mukherjee, Arunava; Mukherjee, D.; Mukherjee, S.; Mukund, N.; Mullavey, A.; Munch, J.; Muniz, E. A. M.; Murray, P. G.; Mytidis, A.; Napier, K.; Nardecchia, I.; Naticchioni, L.; Nelemans, G.; Nelson, T. J. N.; Neri, M.; Nery, M.; Neunzert, A.; Newport, J. M.; Newton, G.; Nguyen, T. T.; Nielsen, A. B.; Nissanke, S.; Nitz, A.; Noack, A.; Nocera, F.; Nolting, D.; Normandin, M. E. N.; Nuttall, L. K.; Oberling, J.; Ochsner, E.; Oelker, E.; Ogin, G. H.; Oh, J. J.; Oh, S. H.; Ohme, F.; Oliver, M.; Oppermann, P.; Oram, Richard J.; O'Reilly, B.; O'Shaughnessy, R.; Ottaway, D. J.; Overmier, H.; Owen, B. J.; Pace, A. E.; Page, J.; Pai, A.; Pai, S. A.; Palamos, J. R.; Palashov, O.; Palomba, C.; Pal-Singh, A.; Pan, H.; Pankow, C.; Pannarale, F.; Pant, B. C.; Paoletti, F.; Paoli, A.; Papa, M. A.; Paris, H. R.; Parker, W.; Pascucci, D.; Pasqualetti, A.; Passaquieti, R.; Passuello, D.; Patricelli, B.; Pearlstone, B. L.; Pedraza, M.; Pedurand, R.; Pekowsky, L.; Pele, A.; Penn, S.; Perez, C. J.; Perreca, A.; Perri, L. M.; Pfeiffer, H. P.; Phelps, M.; Piccinni, O. J.; Pichot, M.; Piergiovanni, F.; Pierro, V.; Pillant, G.; Pinard, L.; Pinto, I. M.; Pitkin, M.; Poe, M.; Poggiani, R.; Popolizio, P.; Post, A.; Powell, J.; Prasad, J.; Pratt, J. W. W.; Predoi, V.; Prestegard, T.; Prijatelj, M.; Principe, M.; Privitera, S.; Prodi, G. A.; Prokhorov, L. G.; Puncken, O.; Punturo, M.; Puppo, P.; Pürrer, M.; Qi, H.; Qin, J.; Qiu, S.; Quetschke, V.; Quintero, E. A.; Quitzow-James, R.; Raab, F. J.; Rabeling, D. S.; Radkins, H.; Raffai, P.; Raja, S.; Rajan, C.; Rakhmanov, M.; Rapagnani, P.; Raymond, V.; Razzano, M.; Re, V.; Read, J.; Regimbau, T.; Rei, L.; Reid, S.; Reitze, D. H.; Rew, H.; Reyes, S. D.; Rhoades, E.; Ricci, F.; Riles, K.; Rizzo, M.; Robertson, N. A.; Robie, R.; Robinet, F.; Rocchi, A.; Rolland, L.; Rollins, J. G.; Roma, V. J.; Romano, J. D.; Romano, R.; Romie, J. H.; Rosińska, D.; Rowan, S.; Rüdiger, A.; Ruggi, P.; Ryan, K.; Sachdev, S.; Sadecki, T.; Sadeghian, L.; Sakellariadou, M.; Salconi, L.; Saleem, M.; Salemi, F.; Samajdar, A.; Sammut, L.; Sampson, L. M.; Sanchez, E. J.; Sandberg, V.; Sanders, J. R.; Sassolas, B.; Sathyaprakash, B. S.; Saulson, P. R.; Sauter, O.; Savage, R. L.; Sawadsky, A.; Schale, P.; Scheuer, J.; Schlassa, S.; Schmidt, E.; Schmidt, J.; Schmidt, P.; Schnabel, R.; Schofield, R. M. S.; Schönbeck, A.; Schreiber, E.; Schuette, D.; Schutz, B. F.; Schwalbe, S. G.; Scott, J.; Scott, S. M.; Sellers, D.; Sengupta, A. S.; Sentenac, D.; Sequino, V.; Sergeev, A.; Setyawati, Y.; Shaddock, D. A.; Shaffer, T. J.; Shahriar, M. S.; Shapiro, B.; Shawhan, P.; Sheperd, A.; Shoemaker, D. H.; Shoemaker, D. M.; Siellez, K.; Siemens, X.; Sieniawska, M.; Sigg, D.; Silva, A. D.; Singer, A.; Singer, L. P.; Singh, A.; Singh, R.; Singhal, A.; Sintes, A. M.; Slagmolen, B. J. J.; Smith, B.; Smith, J. R.; Smith, R. J. E.; Son, E. J.; Sorazu, B.; Sorrentino, F.; Souradeep, T.; Spencer, A. P.; Srivastava, A. K.; Staley, A.; Steinke, M.; Steinlechner, J.; Steinlechner, S.; Steinmeyer, D.; Stephens, B. C.; Stevenson, S. P.; Stone, R.; Strain, K. A.; Straniero, N.; Stratta, G.; Strigin, S. E.; Sturani, R.; Stuver, A. L.; Summerscales, T. Z.; Sun, L.; Sunil, S.; Sutton, P. J.; Swinkels, B. L.; Szczepańczyk, M. J.; Tacca, M.; Talukder, D.; Tanner, D. B.; Tao, D.; Tápai, M.; Taracchini, A.; Taylor, R.; Theeg, T.; Thomas, E. G.; Thomas, M.; Thomas, P.; Thorne, K. A.; Thrane, E.; Tippens, T.; Tiwari, S.; Tiwari, V.; Tokmakov, K. V.; Toland, K.; Tomlinson, C.; Tonelli, M.; Tornasi, Z.; Torrie, C. I.; Töyrä, D.; Travasso, F.; Traylor, G.; Trifirò, D.; Trinastic, J.; Tringali, M. C.; Trozzo, L.; Tse, M.; Tso, R.; Turconi, M.; Tuyenbayev, D.; Ugolini, D.; Unnikrishnan, C. S.; Urban, A. L.; Usman, S. A.; Vahlbruch, H.; Vajente, G.; Valdes, G.; van Bakel, N.; van Beuzekom, M.; van den Brand, J. F. J.; Van Den Broeck, C.; Vander-Hyde, D. C.; van der Schaaf, L.; van Heijningen, J. V.; van Veggel, A. A.; Vardaro, M.; Varma, V.; Vass, S.; Vasúth, M.; Vecchio, A.; Vedovato, G.; Veitch, J.; Veitch, P. J.; Venkateswara, K.; Venugopalan, G.; Verkindt, D.; Vetrano, F.; Viceré, A.; Viets, A. D.; Vinciguerra, S.; Vine, D. J.; Vinet, J.-Y.; Vitale, S.; Vo, T.; Vocca, H.; Vorvick, C.; Voss, D. V.; Vousden, W. D.; Vyatchanin, S. P.; Wade, A. R.; Wade, L. E.; Wade, M.; Walker, M.; Wallace, L.; Walsh, S.; Wang, G.; Wang, H.; Wang, M.; Wang, Y.; Ward, R. L.; Warner, J.; Was, M.; Watchi, J.; Weaver, B.; Wei, L.-W.; Weinert, M.; Weinstein, A. J.; Weiss, R.; Wen, L.; Weßels, P.; Westphal, T.; Wette, K.; Whelan, J. T.; Whiting, B. F.; Whittle, C.; Williams, D.; Williams, R. D.; Williamson, A. R.; Willis, J. L.; Willke, B.; Wimmer, M. H.; Winkler, W.; Wipf, C. C.; Wittel, H.; Woan, G.; Woehler, J.; Worden, J.; Wright, J. L.; Wu, D. S.; Wu, G.; Yam, W.; Yamamoto, H.; Yancey, C. C.; Yap, M. J.; Yu, Hang; Yu, Haocun; Yvert, M.; ZadroŻny, A.; Zangrando, L.; Zanolin, M.; Zendri, J.-P.; Zevin, M.; Zhang, L.; Zhang, M.; Zhang, T.; Zhang, Y.; Zhao, C.; Zhou, M.; Zhou, Z.; Zhu, S. J.; Zhu, X. J.; Zucker, M. E.; Zweizig, J.; LIGO Scientific Collaboration; Virgo Collaboration

    2017-03-01

    We employ gravitational-wave radiometry to map the stochastic gravitational wave background expected from a variety of contributing mechanisms and test the assumption of isotropy using data from the Advanced Laser Interferometer Gravitational Wave Observatory's (aLIGO) first observing run. We also search for persistent gravitational waves from point sources with only minimal assumptions over the 20-1726 Hz frequency band. Finding no evidence of gravitational waves from either point sources or a stochastic background, we set limits at 90% confidence. For broadband point sources, we report upper limits on the gravitational wave energy flux per unit frequency in the range Fα ,Θ(f )<(0.1 - 56 )×10-8 erg cm-2 s-1 Hz-1(f /25 Hz )α -1 depending on the sky location Θ and the spectral power index α . For extended sources, we report upper limits on the fractional gravitational wave energy density required to close the Universe of Ω (f ,Θ )<(0.39 - 7.6 )×10-8 sr-1(f /25 Hz )α depending on Θ and α . Directed searches for narrowband gravitational waves from astrophysically interesting objects (Scorpius X-1, Supernova 1987 A, and the Galactic Center) yield median frequency-dependent limits on strain amplitude of h0<(6.7 ,5.5 , and 7.0 )×10-25 , respectively, at the most sensitive detector frequencies between 130-175 Hz. This represents a mean improvement of a factor of 2 across the band compared to previous searches of this kind for these sky locations, considering the different quantities of strain constrained in each case.

  2. [Advance directives in Italy: a goal not yet reached but already passed?].

    PubMed

    Riccioni, Luigi; Gristina, Giuseppe

    2015-10-01

    The advance directives (ADs) have been adopted in many countries to defend patients' autonomy. In Italy, in the past, this topic gave rise to a heated debate involving philosophers, theologians, and politicians. In 2009, the government presented a bill of law on ADs firmly criticized from a scientific, moral and juridical point of view because the bill's content is against the principles of Italian Constitution, Italian Code of Medical Ethics, Oviedo Convention, and official statements of many scientific societies. Although the bill has passed the Low Chamber it lies, even since, in the Senate, lacking in regard any agreement among the political parties. The purpose of this article is to highlight that, in our country, patients, relatives and doctors deserve a law not only related to the specific topic of ADs, but - as in other European countries (Germany, Spain, France, UK) - aimed to deal with the complex issue of end of life care as a whole. This law should take into account the sound evidence existing in regard to the four fundamental principles supporting the best scientific and ethical approaches to the end of life issues: shared decision making process between doctors and patients/relatives; rejection of dying process marked by the suffering; withholding/withdrawing futile treatments together with palliative sedation as two crucial contributions to suppress the patient suffering and pain; clear-cut difference between these clinical/ethical options and euthanasia. At the same time, this law should be able to provide physicians with a legal coverage to make all the clinical and ethical decisions more and more complex because of the continuous evolution of medical science on one hand, and the impressive development of biotechnology on the other hand.

  3. Default options in advance directives: study protocol for a randomised clinical trial

    PubMed Central

    Gabler, Nicole B; Cooney, Elizabeth; Small, Dylan S; Troxel, Andrea B; Arnold, Robert M; White, Douglas B; Angus, Derek C; Loewenstein, George; Volpp, Kevin G; Bryce, Cindy L; Halpern, Scott D

    2016-01-01

    Introduction Although most seriously ill Americans wish to avoid burdensome and aggressive care at the end of life, such care is often provided unless patients or family members specifically request otherwise. Advance directives (ADs) were created to provide opportunities to set limits on aggressive care near life's end. This study tests the hypothesis that redesigning ADs such that comfort-oriented care is provided as the default, rather than requiring patients to actively choose it, will promote better patient-centred outcomes. Methods and analysis This multicentre trial randomises seriously ill adults to receive 1 of 3 different ADs: (1) a traditional AD that requires patients to actively choose their goals of care or preferences for specific interventions (eg, feeding tube insertion) or otherwise have their care guided by their surrogates and the prevailing societal default toward aggressive care; (2) an AD that defaults to life-extending care and receipt of life-sustaining interventions, enabling patients to opt out from such care; or (3) an AD that defaults to comfort care, enabling patients to opt into life-extending care. We seek to enrol 270 patients who return complete, legally valid ADs so as to generate sufficient power to detect differences in the primary outcome of hospital-free days (days alive and not in an acute care facility). Secondary outcomes include hospital and intensive care unit admissions, costs of care, hospice usage, decision conflict and satisfaction, quality of life, concordance of preferences with care received and bereavement outcomes for surrogates of patients who die. Ethics and dissemination This study has been approved by the Institutional Review Boards at all trial centres, and is guided by a data safety and monitoring board and an ethics advisory board. Study results will be disseminated using methods that describe the results in ways that key stakeholders can best understand and implement. Trial registration number NCT02017548

  4. Doctorate in nursing practice: a survey of massachusetts nurses.

    PubMed

    DeMarco, Rosanna F; Pulcini, Joyce; Haggerty, Lois A; Tang, Trinh

    2009-01-01

    Recently, the American Association of Colleges of Nursing (AACN) resolved that a new practice degree, the doctorate in nursing practice (DNP), is to become the terminal practice degree and minimum education standard for advanced practice nurses by the year 2015(American Association of Colleges of Nursing. (2004). AACN position statement on the practice doctorate in nursing. Retrieved July 1, 2007, from http://www.aacn.nche.edu.html). The DNP will have a clinical-intensive focus. Advanced practice nurses potentially impacted by this resolution will include nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists. A task force at the William F. Connell School of Nursing at Boston College conducted an electronic survey in 2006 in an attempt to understand nurses' thoughts about doctoral preparation and the interest of nurses in Massachusetts in pursuing doctoral study. A self-selected group of 376 nurses participated in the study. Nurses identified both positive and negative perceptions related to the degree's viability and practicality, with a majority (55%) preferring the DNP as an educational option.

  5. Globalisation as we enter the 21st century: reflections and directions for nursing education, science, research and clinical practice.

    PubMed

    Davidson, Patricia M; Meleis, Afaf; Daly, John; Douglas, Marilyn Marty

    2003-10-01

    The events of September 11th, 2001 in the United States and the Bali bombings of October 2002 are chastening examples of the entangled web of the religious, political, health, cultural and economic forces we experience living in a global community. To view these forces as independent, singular, linearly deterministic entities of globalisation is irrational and illogical. Understanding the concept of globalisation has significant implications not only for world health and international politics, but also the health of individuals. Depending on an individual's political stance and world-view, globalisation may be perceived as an emancipatory force, having the potential to bridge the chasm between rich and poor or, in stark contrast, the very essence of the divide. It is important that nurses appreciate that globalisation does not pertain solely to the realms of economic theory and world politics, but also that it impacts on our daily nursing practice and the welfare of our patients. Globalisation and the closer interactions of human activity that result, have implications for international governance, policy and theory development as well as nursing education, research and clinical practice. Nurses, individually and collectively, have the political power and social consciousness to influence the forces of globalisation to improve health for all. This paper defines and discusses globalisation in today's world and its implications for contemporary nursing education, science, research and clinical practice.

  6. Nursing informatics competences still challenging nurse educators.

    PubMed

    Rajalahti, Elina; Saranto, Kaija

    2012-01-01

    In recent years nursing documentation has been one of the most important development areas of nursing informatics (NI) in Finland. The purpose of this study is to describe the development of the nurse educators' competences in nursing documentation during a project called eNNI. The eNNI project (2008-2010) was a cooperative project by nurse educators and working life experts. The goal of the project was to implement the national documentation model and thereby improve operational processes at workplaces. The study includes pre- and post-test questioning of NI applications with a web-based questionnaire (n=136). The data were analyzed with distribution, cross-tabulations and average tests and descriptive statistic multivariate method. According to the results, the ICT skills of the nurse educators were good at the end of the project, and they had good information literacy competence. On the other hand, their advanced NI skills left room for improvement.

  7. Advancements in the development of a directional-position sensing fast neutron detector using acoustically tensioned metastable fluids

    NASA Astrophysics Data System (ADS)

    Archambault, Brian C.; Webster, Jeffrey A.; Grimes, Thomas F.; Fischer, Kevin F.; Hagen, Alex R.; Taleyakhan, Rusi P.

    2015-06-01

    Advancements in the development of a direction and position sensing fast neutron detector which utilizes the directional acoustic tensioned metastable fluid detector (D-ATMFD) are described. The resulting D-ATMFD sensor is capable of determining the direction of neutron radiation with a single compact detector versus use of arrays of detectors in conventional directional systems. Directional neutron detection and source positioning offer enhanced detection speeds in comparison to traditional proximity searching; including enabling determination of the neutron source shape, size, and strength in near real time. This paper discusses advancements that provide the accuracy and precision of ascertaining directionality and source localization information utilizing enhanced signal processing-cum-signal analysis, refined computational algorithms, and on-demand enlargement capability of the detector sensitive volume. These advancements were accomplished utilizing experimentation and theoretical modeling. Benchmarking and qualifications studies were successfully conducted with random and fission based special nuclear material (SNM) neutron sources (239Pu-Be and 252Cf). These results of assessments have indicated that the D-ATMFD compares well in technical performance with banks of competing directional fast neutron detector technologies under development worldwide, but it does so with a single detector unit, an unlimited field of view, and at a significant reduction in both cost and size while remaining completely blind to common background (e.g., beta-gamma) radiation. Rapid and direct SNM neutron source imaging with two D-ATMFD sensors was experimentally demonstrated, and furthermore, validated via multidimensional nuclear particle transport simulations utilizing MCNP-PoliMi. Characterization of a scaled D-ATMFD based radiation portal monitor (RPM) as a cost-effective and efficient 3He sensor replacement was performed utilizing MCNP-PoliMi simulations, the results of which

  8. Sigma Team for Advanced Actinide Recycle FY2015 Accomplishments and Directions

    SciTech Connect

    Moyer, Bruce A.

    2015-09-30

    noncomplexing aqueous solution and submission of this scientific breakthrough as a paper in Science; The first-ever co-crystallization of Am(VI) with UO2(NO3)2 ∙ 6H2O, opening the door to a new approach for separating hexavalent actinides as a group; Results showing that three potentially problematic metals will not present risk in ALSEP; Improvement in ALSEP contactor stripping kinetics to acceptable performance; A comparison of centrifugal contactors vs mixer-settlers showing the former performs better in ALSEP stripping; Synthesis of new mixed N,O-donor extractants with enhanced solubility and strength for selective trivalent actinide extraction; Development of computational methods showing promise in prediction of the selectivity of new extractants for trivalent actinides vs lanthanides; An order-of-magnitude improvement in aqueous Am/Eu complexation selectivity of an alternative macrocyclic stripping agent for ALSEP, potentially enabling an option for an Am product stream free from both Ln and Cm. An alternative aqueous combination of dipicolinate complexant and malonate buffer that may present options for ALSEP and TALSPEAK (Trivalent Actinide-Lanthanide Separations by Phosphorus-reagent Extraction from Aqueous Komplexes) type separations. The ALSEP concept is advancing toward a benchtop flowsheet demonstration planned for FY 2016, and a bench-scale test bed at Idaho National Laboratory (INL) will be employed to demonstrate at least one tandem Am oxidation and separation concept. This report outlines the goals of the STAAR, significance of achieving these goals, STAAR organization around the above aims and questions, recent highlights, and future directions. The report also includes a listing of publications, reports, patents, and dissertations.

  9. Nurse Mentors to Advance Quality Improvement in Primary Health Centers: Lessons From a Pilot Program in Northern Karnataka, India.

    PubMed

    Fischer, Elizabeth A; Jayana, Krishnamurthy; Cunningham, Troy; Washington, Maryann; Mony, Prem; Bradley, Janet; Moses, Stephen

    2015-12-01

    High-quality care during labor, delivery, and the postpartum period is critically important since maternal and child morbidity and mortality are linked to complications that arise during these stages. A nurse mentoring program was implemented in northern Karnataka, India, to improve quality of services at primary health centers (PHCs), the lowest level in the public health system that offers basic obstetric care. The intervention, conducted between August 2012 and July 2014, employed 53 full-time nurse mentors and was scaled-up in 385 PHCs in 8 poor rural districts. Each mentor was responsible for 6 to 8 PHCs and conducted roughly 6 mentoring visits per PHC in the first year. This paper reports the results of a qualitative inquiry, conducted between September 2012 and April 2014, assessing the program's successes and challenges from the perspective of mentors and PHC teams. Data were gathered through 13 observations, 9 focus group discussions with mentors, and 25 individual and group interviews with PHC nurses, medical officers, and district health officers. Mentors and PHC staff and leaders reported a number of successes, including development of rapport and trust between mentors and PHC staff, introduction of team-based quality improvement processes, correct and consistent use of a new case sheet to ensure adherence to clinical guidelines, and increases in staff nurses' knowledge and skills. Overall, nurses in many PHCs reported an increased ability to provide care according to guidelines and to handle maternal and newborn complications, along with improvements in equipment and supplies and referral management. Challenges included high service delivery volumes and/or understaffing at some PHCs, unsupportive or absent PHC leadership, and cultural practices that impacted quality. Comprehensive mentoring can build competence and improve performance by combining on-the-job clinical and technical support, applying quality improvement principles, and promoting team

  10. Iowa nurses' knowledge of living wills and perceptions of patient autonomy.

    PubMed

    Weiler, K; Eland, J; Buckwalter, K C

    1996-01-01

    The principle of patient autonomy is well recognized in the nursing profession. This study extends the exploration of patient autonomy by examining nurses' knowledge about living wills. The questions addressed in this study included the following: (1) Were Iowa nurses aware of the living will statute? (2) What sources of information did nurses use to learn about this legislation? (3) What were nurses' perceptions of patients' rights? (4) What were nurses' perceptions of nurses' role involving living wills? (5) Were living wills followed? (6) If not followed, which factors contributed to the failure to honor a living will? and (7) Which communication mechanisms were used to alert nurses to a living will? A questionnaire was mailed to 10,000 actively licensed nurses in Iowa. Approximately 3,000 Iowa nurses responded to the questionnaire regarding Iowa living wills. Seventy per cent of the nurses knew that Iowa had living will legislation. No single educational source was a predominate choice for targeted information about the living will statute. Nurses were reluctant to suggest to patients that they should consider writing a living will. Nurses were also more willing to assume a passive role of suggesting that patients talk with relatives about the need for a living will but were less likely to be suggest that a patient write a living will for future health care treatment decisions. The majority of the nurses favored the patient having some control in health care treatment decisions. Three major factors were pertinent to the failure to follow a living will: family request, treating physician's refusal, and lack of information that the living will existed. The medical record was the primary means of communication regarding a living will. To enhance patient efforts at self-determination, nurses must recognize the advance directive legislation is available in their state and the potential impact that their nursing care may have on the implementation of the document.

  11. Advance Directives and Communication Skills of Prehospital Physicians Involved in the Care of Cardiovascular Patients.

    PubMed

    Gigon, Fabienne; Merlani, Paolo; Ricou, Bara

    2015-12-01

    Advance directives (AD) were developed to respect patient autonomy. However, very few patients have AD, even in cases when major cardiovascular surgery is to follow. To understand the reasons behind the low prevalence of AD and to help decision making when patients are incompetent, it is necessary to focus on the impact of prehospital practitioners, who may contribute to an increase in AD by discussing them with patients. The purpose of this study was to investigate self-rated communication skills and the attitudes of physicians potentially involved in the care of cardiovascular patients toward AD.Self-administered questionnaires were sent to general practitioners, cardiologists, internists, and intensivists, including the Quality of Communication Score, divided into a General Communication score (QOCgen 6 items) and an End-of-life Communication score (QOCeol 7 items), as well as questions regarding opinions and practices in terms of AD.One hundred sixty-four responses were received. QOCgen (mean (±SD)): 9.0/10 (1.0); QOCeol: 7.2/10 (1.7). General practitioners most frequently start discussions about AD (74/149 [47%]) and are more prone to designate their own specialty (30/49 [61%], P < 0.0001). Overall, only 57/159 (36%) physicians designated their own specialty; 130/158 (82%) physicians ask potential cardiovascular patients if they have AD and 61/118 (52%) physicians who care for cardiovascular patients talk about AD with some of them.The characteristics of physicians who do not talk about AD with patients were those who did not personally have AD and those who work in private practices.One hundred thirty-three (83%) physicians rated the systematic mention of patients' AD in the correspondence between physicians as good, while 114 (71%) at the patients' first registration in the private practice.Prehospital physicians rated their communication skills as good, whereas end-of-life communication was rated much lower. Only half of those surveyed speak about AD

  12. 38 CFR 51.130 - Nursing services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... service must be under the direction of a full-time registered nurse who is currently licensed by the State... nurses 24 hours per day, 7 days per week. (c) The director of nursing service must designate a registered nurse as a supervising nurse for each tour of duty. (1) Based on the application and results of the...

  13. Comparison of Successful Intubation Between Video Laryngoscopy View Before Attempted Intubation and Direct Laryngoscopic Intubation by Student Registered Nurse Anesthetists: A Pilot Study.

    PubMed

    Wands, Brenda; Minzola, Debra

    2015-12-01

    Airway management is a primary focus when student registered nurse anesthetists (SRNAs) begin clinical rotations in their nurse anesthesia program. Successful endotracheal intubation requires both knowledge of and experience with the airway and its structures. Lack of clinical maturity and unfamiliarity with the patient airway intensifies student anxiety in the clinical arena. The purpose of this pilot study was to examine the success rate of direct laryngoscopy by 9 SRNAs who were just entering clinical practice rotations. This study required group 1 to perform direct laryngoscopy in their first clinical opportunity in the operating room; group 2 was required to observe a minimum of 3 video laryngoscopic (GlideScope, Verathon Inc) intubations performed by the clinical preceptor before the students' first attempt using direct laryngoscopy. Other modalities used to secure the airway in this study included the GlideScope and a laryngeal mask airway. Results of the data analysis revealed there was no significant difference between groups for success of direct laryngoscopy (group 1, 54%; group 2, 58%; P = .45).

  14. Hospital Nurse Aide. Revised.

    ERIC Educational Resources Information Center

    Iowa Univ., Iowa City. Coll. of Education.

    This report presents results of a project to revise the current 120-hour advanced nurse aide course to include all recommended minimum competencies. A three-page description of project objectives, activities, and outcomes is followed by a list of the competencies for the 75-hour nurse aide course for long-term care and for the 120-hour advanced…

  15. The Impact of an Educational Intervention on Self-Directed Learning Readiness and Behaviors in Undergraduate Nursing Students

    ERIC Educational Resources Information Center

    Daniels, Elizabeth Barnes

    2011-01-01

    This study compared the SDL readiness and behaviors of two homogeneous groups of junior level undergraduate nursing students (n = 33) as measured by Guglielmino's SDLRS. One group was exposed to an educational module that addressed the purpose and process of SDL and the other was not exposed to the educational module. An experimental,…

  16. Child maltreatment: every nurse's business.

    PubMed

    Taylor, Julie; Bradbury-Jones, Caroline

    2015-03-18

    Every nurse has a responsibility for protecting children, even nurses who do not work directly with children. However, nurses may be reluctant to deal with child maltreatment issues because they do not want to get things wrong or make a situation worse. The aim of this article is to assist nurses in their child protection role. It describes the different types of child maltreatment, the risk factors and potential consequences. The nurse's role in recognising and responding to suspected child maltreatment is discussed.

  17. The relationship between apathy and participation in therapeutic activities in nursing home residents with dementia: Evidence for an association and directions for further research.

    PubMed

    Ellis, Julie M; Doyle, Colleen J; Selvarajah, Suganya

    2016-07-01

    Apathy is one of the most frequent and early symptoms of dementia. Because apathy is characterised by lack of initiative and motivation, it leads to considerable burden being placed on carers to ensure that the person living with dementia has a reasonable quality of life. The aim of this study was to investigate the relationship between apathy and participation in therapeutic activities for older people with dementia living in nursing homes. Ninety residents were recruited into the study, and apathy was measured by nursing home staff using the Apathy Evaluation Scale Clinician version. Staff also compiled data on each resident's involvement in therapeutic activities. Among this sample, the mean age was 84.8 years, and mean length of stay in the nursing home was 1.8 years. The mean apathy score was 50.4, indicating that on average the residents had a moderate level of apathy. Overall, residents participated in six activities per week and those residents who were involved in the most activities had the lowest levels of apathy. This paper provides evidence that residents involved in therapeutic activities have lower levels of apathy. Further research should be conducted on the direction of causality, whether apathy levels can be changed through participation in therapeutic activities, the relationship between dementia severity and modifiability of apathy, and the intensity of therapeutic activities required to maintain functioning.

  18. The impact of Roman Catholic moral theology on end-of-life care under the Texas Advance Directives Act.

    PubMed

    Zientek, David M

    2006-04-01

    This essay reviews the Roman Catholic moral tradition surrounding treatments at the end of life together with the challenges presented to that tradition by the Texas Advance Directives Act. The impact on Catholic health care facilities and physicians, and the way in which the moral tradition should be applied under this statute, particularly with reference to the provision dealing with conflicts over end-of-life treatments, will be critically assessed. I will argue, based on the traditional treatment of end-of-life issues, that Catholic physicians and institutions should appeal to the conflict resolution process of the Advance Directives Act only under a limited number of circumstances. The implications, under the Texas statute, of varied interpretations of Pope John Paul II's recent allocution on artificial feeding and hydration in the persistent vegetative state will also be considered.

  19. Advances in the management of melanoma: targeted therapy, immunotherapy and future directions.

    PubMed

    Dean, Emma; Lorigan, Paul

    2012-11-01

    Metastatic melanoma is an aggressive, immunogenic and molecularly heterogeneous disease for which most patients require systemic treatment. Recently, significant clinical breakthroughs have revolutionized the treatment of advanced melanoma, leading to the licensing of ipilimumab, a monoclonal antibody targeting cytotoxic T-lymphocyte-associated antigen 4, and vemurafenib, a BRAF inhibitor used in patients whose tumors contain a V600 mutation in the BRAF gene. This recent success has led to optimism and momentum has gathered with updated trial results from these therapies, next-generation compounds that target validated molecular pathways and novel agents that are mechanistically distinct. This review summarizes the recent advances and updated results since the licensing of vemurafenib and ipilimumab, the benefits and limitations of these agents, future strategies to improve upon existing treatments and overcome acquired resistance, in-progress and future clinical trials, as well as novel therapeutic targets, pathways and therapies that hold promise in advancing clinical benefit.

  20. Impact of a Care Directives Activity Tab in the Electronic Health Record on Documentation of Advance Care Planning

    PubMed Central

    Turley, Marianne; Wang, Susan; Meng, Di; Kanter, Michael; Garrido, Terhilda

    2016-01-01

    Context: To ensure patient-centered end-of-life care, advance care planning (ACP) must be documented in the medical record and readily retrieved across care settings. Objective: To describe use of the Care Directives Activity tab (CDA), a single-location feature in the electronic health record for collecting and viewing ACP documentation in inpatient and ambulatory care settings, and to assess its association with ACP documentation rates. Design: Retrospective pre- and postimplementation analysis in 2012 and 2013 at Kaiser Permanente Southern California among 113,309 patients aged 65 years and older with ACP opportunities during outpatient or inpatient encounters. Main Outcome Measures: Providers’ CDA use rates and documentation rates of advance directives and physician orders for life-sustaining treatments stratified by CDA use. Results: Documentation rates of advance directives and physician orders for life-sustaining treatments among patients with outpatient and inpatient encounters were 3.5 to 9.6 percentage points higher for patients with CDA use vs those without it. The greatest differences were for orders for life-sustaining treatments among patients with inpatient encounters and for advance directives among patients with outpatient encounters; both were 9.6 percentage points higher among those with CDA use than those without it. All differences were significant after controlling for yearly variation (p < 0.001). Conclusion: Statistically significant differences in documentation rates between patients with and without CDA use suggest the potential of a standardized location in the electronic health record to improve ACP documentation. Further research is required to understand effects of CDA use on retrieval of preferences and end-of-life care. PMID:27057820

  1. Advanced Life Support Water Recycling Technologies Case Studies: Vapor Phase Catalytic Ammonia Removal and Direct Osmotic Concentration

    NASA Technical Reports Server (NTRS)

    Flynn, Michael

    2004-01-01

    Design for microgravity has traditionally not been well integrated early on into the development of advanced life support (ALS) technologies. NASA currently has a many ALS technologies that are currently being developed to high technology readiness levels but have not been formally evaluated for microgravity compatibility. Two examples of such technologies are the Vapor Phase Catalytic Ammonia Removal Technology and the Direct Osmotic Concentration Technology. This presentation will cover the design of theses two systems and will identify potential microgravity issues.

  2. Self-image of male nursing students in Hong Kong: multi-qualitative approaches.

    PubMed

    Chan, Zenobia C Y; Lo, Kelvin K L; Tse, Kris C Y; Wong, William W

    2014-01-01

    The image of male nurses is closely related to the development of a female-driven nursing occupation. As a minority group in the nursing industry, male nursing students may have a negative self-image in their learning and clinical practicum. This may affect their psychological health and mental status. This study explored the positive and negative self-image of male nursing students. Eighteen participants were recruited from a local nurse-training institute. The participants were undergraduate bachelor's and master's students of nursing. The experience and opinions of the participants were collected by multiple methods. The participants' drawings and audio diaries representing their self-image as nurses were collected in advance of a discussion of ideas raised in the focus group interview. The findings were categorized into three themes: (a) self-roles, functions, and identities; (b) awareness of gender differences; and (c) the future of professional development. The findings of this study provide information on the nurse role, identity, gender differences, and professional development of male nursing students, which will drive the direction of the development of a positive image for male nurses in the future.

  3. Nurse Mentors to Advance Quality Improvement in Primary Health Centers: Lessons From a Pilot Program in Northern Karnataka, India

    PubMed Central

    Fischer, Elizabeth A; Jayana, Krishnamurthy; Cunningham, Troy; Washington, Maryann; Mony, Prem; Bradley, Janet; Moses, Stephen

    2015-01-01

    High-quality care during labor, delivery, and the postpartum period is critically important since maternal and child morbidity and mortality are linked to complications that arise during these stages. A nurse mentoring program was implemented in northern Karnataka, India, to improve quality of services at primary health centers (PHCs), the lowest level in the public health system that offers basic obstetric care. The intervention, conducted between August 2012 and July 2014, employed 53 full-time nurse mentors and was scaled-up in 385 PHCs in 8 poor rural districts. Each mentor was responsible for 6 to 8 PHCs and conducted roughly 6 mentoring visits per PHC in the first year. This paper reports the results of a qualitative inquiry, conducted between September 2012 and April 2014, assessing the program's successes and challenges from the perspective of mentors and PHC teams. Data were gathered through 13 observations, 9 focus group discussions with mentors, and 25 individual and group interviews with PHC nurses, medical officers, and district health officers. Mentors and PHC staff and leaders reported a number of successes, including development of rapport and trust between mentors and PHC staff, introduction of team-based quality improvement processes, correct and consistent use of a new case sheet to ensure adherence to clinical guidelines, and increases in staff nurses’ knowledge and skills. Overall, nurses in many PHCs reported an increased ability to provide care according to guidelines and to handle maternal and newborn complications, along with improvements in equipment and supplies and referral management. Challenges included high service delivery volumes and/or understaffing at some PHCs, unsupportive or absent PHC leadership, and cultural practices that impacted quality. Comprehensive mentoring can build competence and improve performance by combining on-the-job clinical and technical support, applying quality improvement principles, and promoting team

  4. Handbook of clinical nursing practice

    SciTech Connect

    Asheervath, J.; Blevins, D.R.

    1986-01-01

    Written in outline format, this reference will help nurses further their understanding of advanced nursing procedures. Information is provided on the physiological, psychological, environmental, and safety considerations of nursing activities associated with diagnostic and therapeutic procedures. Special consideration is given to the areas of pediatric nursing, nursing assessment, and selected radiologic and nuclear medicine procedures for each system. Contents: Clinical Introduction. Clinical Nursing Practice: Focus on Basics. Focus on Cardiovascular Function. Focus on Respiratory Function. Focus on Gastrointestinal Function. Focus on Renal and Genito-Urological Function. Focus on Neuro-Skeletal and Muscular Function. Appendices.

  5. Interprofessional Obstetric Ultrasound Education: Successful Development of Online Learning Modules; Case-Based Seminars; and Skills Labs for Registered and Advanced Practice Nurses, Midwives, Physicians, and Trainees.

    PubMed

    Shaw-Battista, Jenna; Young-Lin, Nichole; Bearman, Sage; Dau, Kim; Vargas, Juan

    2015-01-01

    Ultrasound is an important aid in the clinical diagnosis and management of normal and complicated pregnancy and childbirth. The technology is widely applied to maternity care in the United States, where comprehensive standard ultrasound examinations are routine. Targeted scans are common and used for an increasing number of clinical indications due to emerging research and a greater availability of equipment with better image resolution at lower cost. These factors contribute to an increased demand for obstetric ultrasound education among students and providers of maternity care, despite a paucity of data to inform education program design and evaluation. To meet this demand, from 2012 to 2015 the University of California, San Francisco nurse-midwifery education program developed and implemented an interprofessional obstetric ultrasound course focused on clinical applications commonly managed by maternity care providers from different professions and disciplines. The course included matriculating students in nursing and medicine, as well as licensed practitioners such as registered and advanced practice nurses, midwives, and physicians and residents in obstetrics and gynecology and family medicine. After completing 10 online modules with a pre- and posttest of knowledge and interprofessional competencies related to teamwork and communication, trainees attended a case-based seminar and hands-on skills practicum with pregnant volunteers. The course aimed to establish a foundation for further supervised clinical training prior to independent practice of obstetric ultrasound. Course development was informed by professional guidelines and clinical and education research literature. This article describes the foundations, with a review of the challenges and solutions encountered in obstetric ultrasound education development and implementation. Our experience will inform educators who wish to facilitate obstetric ultrasound competency development among new and experienced

  6. Filling the gaps: immersing student nurses in specialty nursing and professional associations.

    PubMed

    Vioral, Anna N

    2011-09-01

    The national nursing shortage demands innovative strategies to attract students to the nursing profession. This article provides a potential solution for recruiting and retaining nurses for specialty areas of nursing as well as professional nursing associations by pairing student nurses with professional nurses who belong to nursing associations. An immersion program such as the one described in this article provides a strategy that addresses the nursing work force shortage and professional association membership. The experiential knowledge gained through this type of program may advance the profession throughout the country.

  7. Advance Directives for End-of-Life Care and the Role of Health Education Specialists: Applying the Theory of Reasoned Action

    ERIC Educational Resources Information Center

    Tremethick, Mary Jane; Johnson, Maureen K.; Carter, Mary R.

    2011-01-01

    Quality end-of-life care is subjective and based on individual values and beliefs. An advance directive provides a legal means of communicating these values and beliefs, as well as preferences in regards to end-of-life care when an individual is no longer able to make his or her desires known. In many nations, advance directives are underused…

  8. The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions

    ERIC Educational Resources Information Center

    Gatchel, Robert J.; Peng, Yuan Bo; Peters, Madelon L.; Fuchs, Perry N.; Turk, Dennis C.

    2007-01-01

    The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of…

  9. Mindfulness-Based Stress Reduction in Advanced Nursing Practice: A Nonpharmacologic Approach to Health Promotion, Chronic Disease Management, and Symptom Control.

    PubMed

    Williams, Hants; Simmons, Leigh Ann; Tanabe, Paula

    2015-09-01

    The aim of this article is to discuss how advanced practice nurses (APNs) can incorporate mindfulness-based stress reduction (MBSR) as a nonpharmacologic clinical tool in their practice. Over the last 30 years, patients and providers have increasingly used complementary and holistic therapies for the nonpharmacologic management of acute and chronic diseases. Mindfulness-based interventions, specifically MBSR, have been tested and applied within a variety of patient populations. There is strong evidence to support that the use of MBSR can improve a range of biological and psychological outcomes in a variety of medical illnesses, including acute and chronic pain, hypertension, and disease prevention. This article will review the many ways APNs can incorporate MBSR approaches for health promotion and disease/symptom management into their practice. We conclude with a discussion of how nurses can obtain training and certification in MBSR. Given the significant and growing literature supporting the use of MBSR in the prevention and treatment of chronic disease, increased attention on how APNs can incorporate MBSR into clinical practice is necessary.

  10. Impaired mental well-being and psychosocial risk: a cross-sectional study in female nursing home direct staff

    PubMed Central

    Pélissier, C; Fontana, L; Fort, E; Vohito, M; Sellier, B; Perrier, C; Glerant, V; Couprie, F; Agard, J P; Charbotel, B

    2015-01-01

    Objectives The present study sought to quantify the impaired mental well-being and psychosocial stress experienced by nursing home staff and to determine the relationship between impaired mental well-being assessed on the 12-item General Health Questionnaire (GHQ-12) and exposure to psychosocial stress assessed on Siegrist's effort/reward and overcommitment model. Methods A transverse study was conducted in France on 2471 female employees in 105 nursing homes for the elderly. Personal and occupational data were collected by questionnaire for 668 housekeepers, 1454 nursing assistants and 349 nurses. Results 36.8% of participants (n=896) showed impaired mental well-being, 42.7% (n=1039) overcommitment and 9% (n=224) effort/reward imbalance. Overcommitment (prevalence ratio (PR)=1.27; 95% CI (1.21 to 1.34)) and effort–reward imbalance (PR=1.19; 95% CI (1.12 to 1.27)) were significantly associated with presence of impaired mental well-being after adjustment for personal factors (age and private life events). Taking effort and reward levels into account, the frequency of impaired mental well-being was highest in case of exposure to great extrinsic effort and low rewards of any type: esteem, PR=3.53, 95% CI (3.06 to 4.08); earnings, PR=3.48, 95% CI (2.99 to 4.06); or job security, PR=3.30, 95% CI (2.88 to 3.78). Participants in situations of overcommitment and of effort/reward imbalance were at the highest risk of impaired mental well-being: PR=3.86, 95% CI (3.42 to 4.35). Conclusions Several changes in nursing home organisation can be suggested to reduce staff exposure to factors of psychosocial stress. Qualitative studies of the relation between impaired mental well-being and psychosocial stress in nursing home staff could guide prevention of impaired mental well-being at work. PMID:25829371

  11. Engaging nurses in research utilization.

    PubMed

    Wintersgill, Wendy; Wheeler, Erlinda C

    2012-01-01

    Research skills education is needed for nurses at all levels: novice, intermediate, and advanced. Nurse educators can help novice nurse researchers develop skills such as performing literature searches and critiquing research articles, which are necessary to develop and update clinical practice guidelines and implement evidence-based practice. The purpose of this article is to describe an innovative approach to encourage nurses to perform literature searches and critique research articles as a means to eventually engage in evidence-based practice.

  12. Care coordination for children with complex special health care needs: the value of the advanced practice nurse's enhanced scope of knowledge and practice.

    PubMed

    Looman, Wendy S; Presler, Elizabeth; Erickson, Mary M; Garwick, Ann W; Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M

    2013-01-01

    Efficiency and effectiveness of care coordination depends on a match between the needs of the population and the skills, scope of practice, and intensity of services provided by the care coordinator. Existing literature that addresses the relevance of the advanced practice nurse (APN) role as a fit for coordination of care for children with special health care needs (SHCN) is limited. The objective of this article is to describe the value of the APN's enhanced scope of knowledge and practice for relationship-based care coordination in health care homes that serve children with complex SHCN. The TeleFamilies project is provided as an example of the integration of an APN care coordinator in a health care home for children with SHCN.

  13. The Professionalism of Critical Care Nurse Fellows After Completion of the Critical Care Nurse Fellowship Program.

    PubMed

    Castro, Emily; Click, Elizabeth; Douglas, Sara; Friedman, Isabel

    2016-01-01

    Professionalism is paramount to the formation and functioning of new graduate critical care nurses. In this project, a sample of 110 new graduate nurses used a descriptive self-report electronic survey with Hall's Professionalism Inventory Scale. A great percentage of these new graduate critical care nurse fellows with high professionalism scores may be related to their participation in the Critical Care Nurse Fellowship orientation program. Perhaps, Nursing Professional Development specialists should incorporate classes on professional advancement planning for new graduate nurses.

  14. Overcoming gaps to advance global health equity: a symposium on new directions for research.

    PubMed

    Frenk, Julio; Chen, Lincoln

    2011-02-22

    The 20th anniversary of the groundbreaking report of the Commission on Health Research for Development inspired a Symposium to assess progress made in strengthening essential national health research capacity in developing countries and in global research partnerships. Significant aspects of the health gains achieved in the 20th century can be attributed to the advancement and translation of knowledge, and knowledge continues to occupy center stage amidst growing complexity that characterizes the global health field. The way forward will entail a reinvigoration of research-generated knowledge as a crucial ingredient for global cooperation and global health advances. To do this we will need to overcome daunting gaps, including the divides between domestic and global health, among the disciplines of research (biomedical, clinical, epidemiological, health systems), between clinical and public health approaches, public and private investments, and between knowledge gained and action implemented. Overcoming systematically these obstacles can accelerate progress towards research for equity in health and development.

  15. Advanced method to derive the IMF direction near Mars from cycloidal proton distributions

    NASA Astrophysics Data System (ADS)

    Yamauchi, M.; Futaana, Y.; Fedorov, A.; Kallio, E.; Frahm, R. A.; Lundin, R.; Sauvaud, J.-A.; Winningham, J. D.; Barabash, S.; Holmström, M.

    2008-06-01

    In a previous paper, we showed a method for deriving the interplanetary magnetic field (IMF) orientation from the velocity distribution of ring-like distributed ions as measured by the Ion Mass Analyser (IMA) on board Mars Express (MEX). This method has been improved so that one can derive the IMF orientation from a very limited portion of the ring distributions, i.e., only the highest energy portion of the ring distribution. This method uses the maximum variance direction L instead of the minimum variance direction N, which are derived from manually selected ring data. Because IMA's count rate for a semi-persistent ring distribution is nearly proportional to energy squire, L is most likely aligned to the tangential direction of the ring distribution at its highest energy, and this tangential direction is parallel or anti-parallel to the electric field. A vector product of L and the solar wind direction ( X) gives the IMF orientation projected to the Y- Z plane. The tilt angle of IMF toward the X direction from the Y- Z plane is the same as the angle between the X direction and the ring plane, and is obtained from two methods when the initial speed of the ring ions is estimated to be much smaller than the solar wind speed: (1) angle between the velocity of ring's maximum energy portion and the solar wind vector, and (2) energy ratio between the solar wind and the maximum energy of the ring. The present method is applied to the IMA data from 3 June 2005 (0605-0640 UT) when the Mars Global Surveyor (MGS) magnetometer data are available. Using these data, we also tried to determine the sign of the IMF direction by estimating the evolution direction of the ring ions.

  16. Beyond Florence Nightingale: The General Professional Education of the Nurse.

    ERIC Educational Resources Information Center

    Pounds, Lois A.

    1989-01-01

    Nurses must leave nursing to advance their careers. A rigorous preprofessional science preparation and nursing education at the baccalaureate level followed by a clinical internship is proposed. Nurses would be able to achieve specialty education either by graduate education or through experience and continuing nursing education. (Author/MLW)

  17. Nurses who do not nurse: factors that predict non-nursing work in the U.S. registered nursing labor market.

    PubMed

    Black, Lisa; Spetz, Joanne; Harrington, Charlene

    2010-01-01

    Registered nurses (RNs) who work outside of nursing have seldom been examined. This aim of this study was to compare the 122,178 (4%) of RNs who are employed outside of nursing to those who work in nursing jobs in terms of sociodemographic, market, and political variables to determine if these groups are substantively different from one another. Using a logit regression model, wages were a significant predictor of working outside of nursing for unmarried nurses but not for married nurses. Married and unmarried male nurses were more likely to work outside of nursing. Baccalaureate education, children under age 6, higher family income, and years since graduation increased the odds of working outside of nursing for married nurses. Ultimately, identifying characteristics on which these groups differ may inform future policy directions that could target nurses who may leave nursing at a time when retention efforts might be effective to alter their trajectory away from the profession.

  18. Integrating Health Information Technology Safety into Nursing Informatics Competencies.

    PubMed

    Borycki, Elizabeth M; Cummings, Elizabeth; Kushniruk, Andre W; Saranto, Kaija

    2017-01-01

    Nursing informatics competencies are constantly changing in response to advances in the health information technology (HIT) industry and research emerging from the fields of nursing and health informatics. In this paper we build off the work of Staggers and colleagues in defining nursing informatics competencies at five levels: the beginning nurse, the experienced nurse, the nursing informatics specialist, the nursing informatics innovator and the nursing informatics researcher in the area of HIT safety. The work represents a significant contribution to the literature in the area of nursing informatics competency development as it extends nursing informatics competencies to include those focused on the area of technology-induced errors and HIT safety.

  19. Nursing Supplies

    MedlinePlus

    ... Stages Listen Español Text Size Email Print Share Nursing Supplies Page Content Article Body Throughout most of ... budget. (Nursing equipment also makes wonderful baby gifts.) Nursing Bras A well-made nursing bra that comfortably ...

  20. A directly cooled grating substrate for ALS (Advanced Light Source) undulator beam lines

    SciTech Connect

    DiGennaro, R.; Swain, T.

    1989-08-01

    Design analyses using finite element methods are presented for thermal distortion of water-cooled diffraction grating substrates for a potential application at the LBL Advanced Light Source, demonstrating that refinements in cooling channel configuration and heat flux distribution can significantly reduce optical surface distortion with high heat loads. Using an existing grating substrate design, sensitivity of tangential slope errors due to thermal distortion is evaluated for a variety of thermal boundary conditions, including coolant flow rate and heat transfer film coefficients, surface illumination area and heat distribution profile, and location of the convection cooling surfaces adjacent to the heated region. 1 ref., 5 figs., 2 tabs.

  1. Advancing Nursing Research in the Visual Era: Reenvisioning the Photovoice Process Across Phenomenological, Grounded Theory, and Critical Theory Methodologies.

    PubMed

    Evans-Agnew, Robin A; Boutain, Doris M; Rosemberg, Marie-Anne S

    Photovoice is a powerful research method that employs participant photography for advancing voice, knowledge, and transformative change among groups historically or currently marginalized. Paradoxically, this research method risks exploitation of participant voice because of weak methodology to method congruence. The purposes of this retrospective article are to revisit current interdisciplinary research using photovoice and to suggest how to advance photovoice by improving methodology-method congruence. Novel templates are provided for improving the photovoice process across phenomenological, grounded theory, and critical theory methodologies.

  2. Executive Competencies of Nurses within the Veterans Health Administration: Comparison of Current and Future Nurse Executive Views

    DTIC Science & Technology

    2006-04-24

    Commission found widespread support for the funding of nursing education however, there appears to be no coordinated plan for individual development... nursing education programs and are typically part of graduate nursing education . Future nurse executives without advanced nursing degrees must develop

  3. Practice profile of members of the American College of Nurse-Midwives. Findings of a direct mail survey.

    PubMed

    1997-01-01

    The scope of practice of today's nurse-midwife is much broader than that of the stereotypical "someone who specializes in delivering babies." Today's nurse-midwife sees approximately 140 clients each month and is involved with providing care to the "total" client. This encompasses not only care related to pregnancy, but also well-woman gynecology, nutrition, mental wellness, and primary care. Although the majority of clients seen by CNMs are in their childbearing years, the practice of nurse-midwifery encompasses postmenopausal women as well. When comparing the results of this survey to responses to similar questions posed 3 years earlier, practice size, number of births attended per month, years in practice, and types of conditions treated were answered in a similar fashion. Although the percentage of CNMs reporting pregnancy care activities remains virtually unchanged, a trend toward an increasing CNM role in well-woman gynecology and primary care is seen. About 5% more CNMs now state that well-woman gynecology and primary care are part of their monthly practice than did in the earlier survey. The biggest change in the greater number of CNMs reporting prescribing autonomy and authority over the 3-year period. In the earlier survey, 51% of the polled CNMs reported full prescribing authority versus 84% who report full prescribing autonomy and authority in 1996. The prescriptions CNMs write each week reflect the diversity in their practice, ranging from those for antibiotics and antifungal agents to those for calcium supplements, antidepressants, and tranquilizers. For 19 of the 36 categories of pharmaceuticals included on the survey, at least half of all CNMs report having the opportunity to prescribe or order products during a "typical" week. In total, for these 36 categories, an average of 94 prescriptions/orders are written each week.

  4. Efficacy of Skin-Directed Therapy for Cutaneous Metastases From Advanced Cancer: A Meta-Analysis

    PubMed Central

    Spratt, Daniel E.; Gordon Spratt, Elizabeth A.; Wu, Shenhong; DeRosa, Antonio; Lee, Nancy Y.; Lacouture, Mario E.; Barker, Christopher A.

    2014-01-01

    Purpose To perform the first meta-analysis of the efficacy of skin-directed therapies for cutaneous metastases. Methods MEDLINE, EMBASE, The Cochrane Library, and ClinicalTrials.gov databases were searched for reports of prospective clinical studies published between 1960 and 2013 that assessed the response of skin-directed therapy for cutaneous metastases (47 of 2,955 unique studies were selected). Primary end points of the study were complete and objective response rates. Secondary analyses were preplanned and included subgroup analyses by skin-directed therapy, histology, and recurrence rates. Meta-analyses were performed with random-effect modeling, and extent of heterogeneity between studies was determined with the Cochran Q and I2 tests. Results After applying exclusion criteria, 47 prospective studies of 4,313 cutaneous metastases were assessed. Five skin-directed therapies were identified: electrochemotherapy, photodynamic therapy, radiotherapy, intralesional therapy, and topical therapy. Among all cutaneous metastases, complete response rate was 35.5% (95% CI, 27.6% to 44.3%) and objective response rate was 60.2% (95% CI, 50.6% to 69.0%). Overall recurrence rate was estimated to be 9.2% (95% CI, 3.7% to 21.2%). Melanoma and breast carcinoma comprised 96.8% of all cutaneous metastases studied and had similar objective response rates (54.5% [95% CI, 48.3% to 60.7%] and 54.0% [95% CI, 48.3% to 59.7%], respectively). Grade ≥ 3 toxicity was reported in less than 6% of patients. Conclusion Response to skin-directed therapy for cutaneous metastases is high but heterogeneous across treatment modalities, with low rates of recurrence post-treatment. Treatment was generally well tolerated and conferred improvements in quality of life. Standardization of response criteria for cutaneous metastases and treatment algorithms to optimally use the available skin-directed therapies are needed. PMID:25154827

  5. Integrative review of graduate entry programs in nursing.

    PubMed

    Pellico, Linda Honan; Terrill, Eileen; White, Patricia; Rico, Janet

    2012-01-01

    In this integrative review, the authors report on, summarize, and analyze research conducted on non-nurse college graduates enrolled in master's degree programs in nursing in the United States and Canada, leading to preparation for advanced practice nurse roles. This review demonstrated that non-nurse college graduates successfully develop into registered nurses and advanced practice registered nurses (APRNs) or certified nurse-midwives (CNMs). What is conspicuously absent in the literature is articulation of the process whereby college graduates become nurses and APRNs or CNMs. Given the expansion of graduate entry programs for non-nurse college graduates, along with the recent clarion call to move advanced practice nursing to the postgraduate level, it is time to examine the process. Understanding the process will help faculty refine pedagogy and curricula to support students' transition from non-nurse to both nurse and APRN or CNM.

  6. Use of Advance Directives: A Social Work Perspective on the Myth versus the Reality.

    ERIC Educational Resources Information Center

    Hoffman, Molly K.

    1994-01-01

    Considers Directive to Physician, Durable Power of Attorney for Healthcare Decisions, and Medical Ethics Decision Form. Notes importance of process individuals go through in defining what quality of life means to them. Sees current struggle being individual articulation of one's wishes based on personal definition of quality of life set forth in…

  7. Recent advances in direct C–H arylation: Methodology, selectivity and mechanism in oxazole series

    PubMed Central

    Verrier, Cécile; Lassalas, Pierrik; Théveau, Laure; Quéguiner, Guy; Trécourt, François; Marsais, Francis

    2011-01-01

    Summary Catalytic direct (hetero)arylation of (hetero)arenes is an attractive alternative to traditional Kumada, Stille, Negishi and Suzuki–Miyaura cross-coupling reactions, notably as it avoids the prior preparation and isolation of (hetero)arylmetals. Developments of this methodology in the oxazole series are reviewed in this article. Methodologies, selectivity, mechanism and future aspects are presented. PMID:22238536

  8. Advancing Scientific Reasoning in Upper Elementary Classrooms: Direct Instruction versus Task Structuring

    ERIC Educational Resources Information Center

    Lazonder, Ard W.; Wiskerke-Drost, Sjanou

    2015-01-01

    Several studies found that direct instruction and task structuring can effectively promote children's ability to design unconfounded experiments. The present study examined whether the impact of these interventions extends to other scientific reasoning skills by comparing the inquiry activities of 55 fifth-graders randomly assigned to one of…

  9. Investigation of Ruthenium Dissolution in Advanced Membrane Electrode Assemblies for Direct Methanol Based Fuel Cells Stacks

    NASA Technical Reports Server (NTRS)

    Valdez, T. I.; Firdosy, S.; Koel, B. E.; Narayanan, S. R.

    2005-01-01

    This viewgraph presentation gives a detailed review of the Direct Methanol Based Fuel Cell (DMFC) stack and investigates the Ruthenium that was found at the exit of the stack. The topics include: 1) Motivation; 2) Pathways for Cell Degradation; 3) Cell Duration Testing; 4) Duration Testing, MEA Analysis; and 5) Stack Degradation Analysis.

  10. Recent advances on Zeolite modification for direct alcohol fuel cells (DAFCs)

    NASA Astrophysics Data System (ADS)

    Makertihartha, I. G. B. N.; Zunita, M.; Rizki, Z.; Dharmawijaya, P. T.

    2017-03-01

    The increase of energy demand and global warming issues has driven studies of alternative energy sources. The polymer electrolyte membrane fuel cell (PEMFC) can be an alternative energy source by (partially) replacing the use of fossil fuel which is in line with the green technology concept. However, the usage of hydrogen as a fuel has several disadvantages mainly transportation and storage related to its safety aspects. Recently, alcohol has gained attention as an energy source for fuel cell application, namely direct alcohol fuel cell (DAFC). Among alcohols, high-mass energy density methanol and ethanol are widely used as direct methanol fuel cell (DMFC) and direct ethanol fuel cell (DEFC), respectively. Currently, the performance of DMFC is still rudimentary. Furthermore, the use of ethanol gives some additional privileges such as non-toxic property, renewable, ease of production in great quantity by the fermentation of sugar-containing raw materials. Direct alcohol fuel cell (DAFC) still has weakness in the low proton conductivity and high alcohol crossover. Therefore, to increase the performance of DAFC, modification using zeolite has been performed to improve proton conductivity and decrease alcohol crossover. Zeolite also has high thermal resistance properties, thereby increasing DAFC performance. This paper will discuss briefly about modification of catalyst and membrane for DAFC using zeolite. Zeolite modification effect on fuel cell performance especially proton conductivity and alcohol crossover will be presented in detail.

  11. Conflict engagement: a new model for nurses.

    PubMed

    Gerardi, Debra

    2015-03-01

    This article is one in a series on conflict. It is part of an ongoing series on leadership coordinated by the American Organization of Nurse Executives (AONE), highlighting topics of interest to nurse managers and emerging nurse leaders. The AONE provides leadership, professional development, advocacy, and research to advance nursing practice and patient care, promote nursing leadership excellence, and shape public policy for health care.

  12. Beyond HER2: recent advances and future directions in targeted therapies in esophagogastric cancers

    PubMed Central

    2016-01-01

    Esophagogastric cancers (EGCa) are a leading cause of cancer related mortality worldwide. It has been recognized that they represent heterogenous diseases based on histology and anatomy. However, it is also increasingly evident that these are diverse malignancies based on genetic alterations, and this is increasingly making these diseases amenable to targeted therapies. While epidermal growth factor receptor (EGFR) and mTOR inhibitors have failed to prove effective in the treatment of advanced EGCa, vascular endothelial growth factor (VEGF) inihibitor have now been demonstrated to improve survival, at least in the 2nd line setting of adenocarcinomas. Other promising approaches are being investigated, including targeted therapies such as MET and FGFR inhibitors, as well as immunotherapy and agents that may affect synthetic lethality. PMID:27747090

  13. Advanced direct liquefaction concepts for PETC generic units. Quarterly technical progress report, January--March 1992

    SciTech Connect

    Not Available

    1992-04-01

    In the Advance Coal Liquefaction Concept Proposal (ACLCP) carbon monoxide (CO) and water have been proposed as the primary reagents in the pretreatment process. The main objective of this project is to develop a methodology for pretreating coal under mild conditions based on a combination of existing processes which have shown great promise in liquefaction, extraction and pyrolysis studies. The aim of this pretreatment process is to partially depolymerise the coal, eliminate oxygen and diminish the propensity for retograde reactions during subsequent liquefaction. The desirable outcome of the CO pretreatment step should be: (1) enhanced liquefaction activity and/or selectivity toward products of higher quality due to chemical modification of the coal structure; (2) cleaner downstream products; (3) overall improvement in operability and process economics.

  14. The formation of social reintegration strategies of the psychic suffering carrier: new directions for psychiatric nursing in Brazil.

    PubMed

    Souza, Emilia Jales Simões de; Moreira, Lilian Hortale de Oliveira; Cardoso, Maria Manuela Vila Nova; Ferreira, Rosa Gomes dos Santos; Silva, Thuany Cristine Santos da

    2014-09-01

    This is an exploratory and descriptive study of a qualitative nature. Its objective is to analyse the formation of strategies for social reintegration of the psychic suffering carrier in the practice of nurses working in hospital psychiatric institutions. For this study, we use, as a basis, the concepts and processes of the formation of strategies presented by Isabel Nicholau, 2001. Twelve nurses with health care experience in hospital psychiatric institutions participated in this study, and data collection occurred through semi-structured interviews in the year 2013. The data revealed that, in addition to human, material, and financial resources, institutional support is needed as is articulation and interaction among professionals and services. The importance of the social dimension and of the negotiation process depicts the development of conception of collective and integrated work. We conclude that strategies are emerging from the daily life of work and are not limited to a rational logic of cost and fundraising, but instead are developed through a negotiated process.

  15. The Crosstalk between Tissue Engineering and Pharmaceutical Biotechnology: Recent Advances and Future Directions.

    PubMed

    Pacheco, Daniela P; Reis, Rui L; Correlo, Vítor M; Marques, Alexandra P

    2015-01-01

    Tissue-engineered constructs made of biotechnology-derived materials have been preferred due to their chemical and physical composition, which offers both high versatility and a support to enclose/ incorporate relevant signaling molecules and/or genes known to therapeutically induce tissue repair. Herein, a critical overview of the impact of different biotechnology-derived materials, scaffolds, and recombinant signaling molecules over the behavior of cells, another element of tissue engineered constructs, as well its regulatory role in tissue regeneration and disease progression is given. Additionally, these tissue-engineered constructs evolved to three-dimensional (3D) tissue-like models that, as an advancement of two-dimensional standard culture methods, are expected to be a valuable tool in the field of drug discovery and pharmaceutical research. Despite the improved design and conception of current proposed 3D tissue-like models, advanced control systems to enable and accelerate streamlining and automation of the numerous labor-intensive steps intrinsic to the development of tissue-engineered constructs are still to be achieved. In this sense, this review intends to present the biotechnology- derived materials that are being explored in the field of tissue engineering to generate 3D tissue-analogues and briefly highlight their foremost breakthroughs in tissue regeneration and drug discovery. It also aims to reinforce that the crosstalk between tissue engineering and pharmaceutical biotechnology has been fostering the outcomes of tissue engineering approaches through the use of biotechnology-derived signaling molecules. Gene delivery/therapy is also discussed as a forefront area that represents another cross point between tissue engineering and pharmaceutical biotechnology, in which nucleic acids can be considered a "super pharmaceutical" to drive biological responses, including tissue regeneration.

  16. Development of a Composite Pain Measure for Persons with Advanced Dementia: Exploratory Analyses in Self-Reporting Nursing Home Residents

    PubMed Central

    Ersek, Mary; Polissar, Nayak; Neradilek, Moni Blazej

    2010-01-01

    Context Experts agree that pain assessment in non-communicative persons requires data from sources that do not rely on self-report, including proxy reports, health history, and observation of pain behaviors. However, there is little empirical evidence to guide clinicians in weighting or combining these sources to best approximate the person’s experience. Objectives The aim of this exploratory study was to identify a combination of observer-dependent pain indicators that would be significantly more predictive of self-reported pain intensity than any single indicator. Because self-reported pain is usually viewed as the criterion measure for pain, self-reported usual and worst pain were the dependent variables. Methods The sample consisted of 326 residents (mean age: 83.2 years; 69% female) living in one of 24 nursing homes. Independent variables did not rely on self-report: surrogate reports from certified nursing assistants (CNA IPT), Checklist of Nonverbal Pain Indicators (CNPI), Cornell Scale for Depression in Dementia (CSDD), Pittsburgh Agitation Scale (PAS), number of painful diagnoses, and Minimum Data Set (MDS) pain variables. Results In univariate analyses, the CNA IPT scores were correlated most highly with self-reported pain. The final multivariate model for self-reported usual pain included CNA IPT, CSDD, PAS and education; this model accounted for only 14% of the variance. The more extensive of the two final models for worst pain included MDS pain frequency, CSDD, CNA IPT, CNPI and age (R2 = 0.14). Conclusion Additional research is needed to develop a predictive pain model for nonverbal persons. PMID:21094018

  17. International nursing leadership related to the drugs phenomenon: a case study of the partnership experience between the Inter-American Drug Abuse Control Commission (CICAD) and the University of Alberta--Faculty of Nursing.

    PubMed

    Wright, Maria da Gloria Miotto; Caufield, Catherine; Gray, Genevieve; Olson, Joanne; Ludueña, Alicia del Carmen; Musayon Oblitas, Flor Yesenia; Huaiquian Silva, Julia; David, Helena Maria Scherlowski; Piedra Chavez, Ketty Aracely; Bernal Roldán, Maria Carmen; Cartana, Maria do Horto Fontoura; Allonso Castillo, Maria Magdalena; Pillon, Sandra; Galera, Sueli Aparecida Frari; Randuz, Vera

    2005-01-01

    In this article, the authors discuss the value of international health in advancing the nursing profession through the development of strong leadership in the area of drug demand reduction. Paradigms for nursing leadership are briefly reviewed and linked to the development of the "International Nursing Leadership Institutes" organized by the Inter-American Commission for the Control of Drug Abuse (CICAD). The "International Nursing Leadership Institutes" have facilitated the implementation of Phase III of the CICAD Schools of Nursing Project: a) planning and implementing the first "International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in Latin America", b) development of Regional and National Strategic Plans for Nursing Professionals in the Area of Demand Reduction in Latin America, and c) preparation of a document that provides guidelines on how to include drug content into undergraduate and graduate nursing curricula. The article also brings reflections directly from several of the participants in the first International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in the Americas, offered in collaboration with the Faculty of Nursing at the University of Alberta in Edmonton, Canada. These reflections demonstrate the multiplicity of ways in which this capacity-building program has made it easier for these members of Latin American Schools of Nursing to show leadership in the area of drug demand reduction.

  18. Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy

    PubMed Central

    Sathananthan, Dharshan; Young, Edward; Nind, Garry; George, Biju; Ashby, Angelie; Drummond, Sharon; Redel, Kasia; Green, Neville; Singh, Rajvinder

    2017-01-01

    Background and study aims Physician-directed nurse-administered balanced propofol sedation (PhD NAPS) in patients undergoing endoscopy and/or colonoscopy is being increasingly utilized worldwide. However, this method of sedation is not universally employed in Australian hospitals due to concerns surrounding its safety. The aim of this study was to assess the safety of PhD NAPS in low-risk patients undergoing endoscopy and/or colonoscopy. Patients and methods This study was conducted at a single tertiary teaching hospital in Adelaide, Australia. It was a prospective study involving 1000 patients with an ASA score of 1 – 3 presenting with any indication for endoscopy, colonoscopy or both. A total of 981 patients (451 male) with a mean age of 53 years (range: 16 – 87) were recruited from January 2010 to October 2012. 440 endoscopies, 420 colonoscopies, and 121 combined procedures were performed. The intra-procedural adverse events (AEs) were recorded. Results There were no major intra-procedural adverse events. Minor AEs occurred in 6.42 % of patients, and resolved spontaneously or with intravenous fluid boluses in all cases. Conclusion PhD NAPS is safe when the proceduralist and nursing staff are adequately trained and strict patient selection criteria are used. PMID:28210707

  19. Fluctuating capacity and advance decision-making in Bipolar Affective Disorder — Self-binding directives and self-determination

    PubMed Central

    Gergel, Tania; Owen, Gareth S.

    2015-01-01

    For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being ‘protected’ through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician–patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. PMID:25939286

  20. Advanced Low Conductivity Thermal Barrier Coatings: Performance and Future Directions (Invited paper)

    NASA Technical Reports Server (NTRS)

    Zhu, Dongming; Miller, Robert A.

    2008-01-01

    Thermal barrier coatings will be more aggressively designed to protect gas turbine engine hot-section components in order to meet future engine higher fuel efficiency and lower emission goals. In this presentation, thermal barrier coating development considerations and performance will be emphasized. Advanced thermal barrier coatings have been developed using a multi-component defect clustering approach, and shown to have improved thermal stability and lower conductivity. The coating systems have been demonstrated for high temperature combustor applications. For thermal barrier coatings designed for turbine airfoil applications, further improved erosion and impact resistance are crucial for engine performance and durability. Erosion resistant thermal barrier coatings are being developed, with a current emphasis on the toughness improvements using a combined rare earth- and transition metal-oxide doping approach. The performance of the toughened thermal barrier coatings has been evaluated in burner rig and laser heat-flux rig simulated engine erosion and thermal gradient environments. The results have shown that the coating composition optimizations can effectively improve the erosion and impact resistance of the coating systems, while maintaining low thermal conductivity and cyclic durability. The erosion, impact and high heat-flux damage mechanisms of the thermal barrier coatings will also be described.

  1. Imaging-Genetics in Autism Spectrum Disorder: Advances, Translational Impact, and Future Directions

    PubMed Central

    Ameis, Stephanie H.; Szatmari, Peter

    2012-01-01

    Autism Spectrum Disorder (ASD) refers to a group of heterogeneous neurodevelopmental disorders that are unified by impairments in reciprocal social communication and a pattern of inflexible behaviors. Recent genetic advances have resolved some of the complexity of the genetic architecture underlying ASD by identifying several genetic variants that contribute to the disorder. Different etiological pathways associated with ASD may converge through effects on common molecular mechanisms, such as synaptogenesis, neuronal motility, and axonal guidance. Recently, with more sophisticated techniques, neuroimaging, and neuropathological studies have provided some consistency of evidence that altered structure, activity, and connectivity within complex neural networks is present in ASD, compared to typically developing children. The imaging-genetics approach promises to help bridge the gap between genetic variation, resultant biological effects on the brain, and production of complex neuropsychiatric symptoms. Here, we review recent findings from the developing field of imaging-genetics applied to ASD. Studies to date have indicated that relevant risk genes are associated with alterations in circuits that mediate socio-emotional, visuo-spatial, and language processing. Longitudinal studies ideally focused on early development, in conjunction with investigation for gene–gene, and gene–environment interactions may move the promise of imaging-genetics in ASD closer to the clinical domain. PMID:22615702

  2. Research on outcomes of pediatric traumatic brain injury: current advances and future directions.

    PubMed

    Taylor, H Gerry

    2004-01-01

    The articles in this series demonstrate the diversity of research approaches needed to enhance understanding of the sequelae of traumatic brain injury (TBI) in children. Methods ranged from assessment of information processing deficits to evaluation of the construct validity of cognitive tests, tracking of changes in academic achievement after injury, and measurement of behavior and social outcomes. Several articles considered multiple influences on sequelae, including TBI severity, age at injury, time since injury, and preinjury child characteristics. The findings provide new information on injury consequences and the cognitive correlates of postinjury problems in behavior, achievement, and discourse processing. Continued progress requires additional study of relations between specific forms of neuropathology and outcomes, more comprehensive assessments of environmental influences, and greater efforts to monitor postinjury developmental changes. Other needs include more probing assessments of the effects of TBI on daily functioning and social-emotional outcomes, investigation of the specificity of sequelae and of sources of variability in outcome, and application of models that examine mechanisms of effect. This research will benefit clinical practice, clarify processes underlying children's behavior and learning problems, and advance knowledge of normal development.

  3. Cost-effective technology advancement directions for electric propulsion transportation systems in earth-orbital missions

    NASA Technical Reports Server (NTRS)

    Regetz, J. D., Jr.; Terwilliger, C. H.

    1979-01-01

    The directions that electric propulsion technology should take to meet the primary propulsion requirements for earth-orbital missions in the most cost effective manner are determined. The mission set requirements, state of the art electric propulsion technology and the baseline system characterized by it, adequacy of the baseline system to meet the mission set requirements, cost optimum electric propulsion system characteristics for the mission set, and sensitivities of mission costs and design points to system level electric propulsion parameters are discussed. The impact on overall costs than specific masses or costs of propulsion and power systems is evaluated.

  4. Mentoring practices benefiting pediatric nurses.

    PubMed

    Weese, Meghan M; Jakubik, Louise D; Eliades, Aris B; Huth, Jennifer J

    2015-01-01

    Previous studies examining predictors of pediatric nurse protégé mentoring benefits demonstrated that protégé perception of quality was the single best predictor of mentoring benefits. The ability to identify the mentoring practices that predict specific benefits for individual nurses provides a better understanding of how mentoring relationships can be leveraged within health care organizations promoting mutual mentoring benefits. This descriptive correlational, non-experimental study of nurses at a northeast Ohio, Magnet® recognized, free-standing pediatric hospital advances nursing science by demonstrating how mentoring practices benefit pediatric nurse protégés.

  5. Development of advanced direct perception displays for nuclear power plants to enhance monitoring, control and fault management. Progress report

    SciTech Connect

    Jones, B.; Shaheen, S.; Moray, N.; Sanderson, P.; Reising, D.V.

    1993-05-21

    With recent theoretical and empirical research in basic and applied psychology, human factors, and engineering, it is now sufficient to define an integrated approach to the deign of advanced displays for present and future nuclear power plants. Traditionally, the conventional displays have shown operators the individual variables on gauges, meters, strip charts, etc. This design approach requires the operators to mentally integrate the separately displayed variables and determine the implications for the plant state. This traditional approach has been known as the single-sensor-single-indicator display design and it places an intolerable amount of mental workload on operators during transients and abnormal conditions. This report discusses a new alternative approach which is the use of direct perception interfaces. Direct perception a interfaces display the underlying physical and system constraints of the situation in a directly perceptual way, such that the viewer need not reason about what is seen to identify system states, but can identify the state of the system perceptually. It is expected that displays which show the dynamics of fundamental physical laws should better support operator decisions and diagnoses of plant states. The purpose of this research project is to develop a suite of direct perception displays for PWR nuclear power plant operations.

  6. Statistics used in current nursing research.

    PubMed

    Zellner, Kathleen; Boerst, Connie J; Tabb, Wil

    2007-02-01

    Undergraduate nursing research courses should emphasize the statistics most commonly used in the nursing literature to strengthen students' and beginning researchers' understanding of them. To determine the most commonly used statistics, we reviewed all quantitative research articles published in 13 nursing journals in 2000. The findings supported Beitz's categorization of kinds of statistics. Ten primary statistics used in 80% of nursing research published in 2000 were identified. We recommend that the appropriate use of those top 10 statistics be emphasized in undergraduate nursing education and that the nursing profession continue to advocate for the use of methods (e.g., power analysis, odds ratio) that may contribute to the advancement of nursing research.

  7. 41 CFR 302-10.301 - May I receive an advance of funds when payment is made directly to the carrier by my agency?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... of funds when payment is made directly to the carrier by my agency? 302-10.301 Section 302-10.301... TRANSPORTATION AND STORAGE OF PROPERTY 10-ALLOWANCES FOR TRANSPORTATION OF MOBILE HOMES AND BOATS USED AS A PRIMARY RESIDENCE Advance of Funds § 302-10.301 May I receive an advance of funds when payment is...

  8. Characteristics of gastrointestinal stromal tumours, diagnostic procedure and therapeutic management and main directions of nursing practice in gastrointestinal stromal tumours

    PubMed Central

    Głuszek, Stanisław; Kozieł, Dorota

    2014-01-01

    Gastrointestinal stromal tumours (GIST) constitute a separate group of mesenchymal neoplasms of the gastrointestinal tract. They have been commonly recognized for a few years, they have created a new problem in medical practice. GIST are more often centred in the stomach. They equally affect female and male patients and occur mainly in patients older than 50 years of age. The clinical picture of the tumour is non-specific. Radical surgical treatment and molecularly targeted therapy with tyrosine kinase inhibitors are used in GIST treatment. Nursing practice with reference to GIST danger is connected with biopsychosocial interventions of perioperative, oncological and palliative procedures and involves the area of health education mainly oriented towards shaping preventive procedures which favour early disease detection and support therapy and recovery. PMID:25784835

  9. Proton exchange membrane materials for the advancement of direct methanol fuel-cell technology

    DOEpatents

    Cornelius, Christopher J.

    2006-04-04

    A new class of hybrid organic-inorganic materials, and methods of synthesis, that can be used as a proton exchange membrane in a direct methanol fuel cell. In contrast with Nafion.RTM. PEM materials, which have random sulfonation, the new class of materials have ordered sulfonation achieved through self-assembly of alternating polyimide segments of different molecular weights comprising, for example, highly sulfonated hydrophilic PDA-DASA polyimide segment alternating with an unsulfonated hydrophobic 6FDA-DAS polyimide segment. An inorganic phase, e.g., 0.5 5 wt % TEOS, can be incorporated in the sulfonated polyimide copolymer to further improve its properties. The new materials exhibit reduced swelling when exposed to water, increased thermal stability, and decreased O.sub.2 and H.sub.2 gas permeability, while retaining proton conductivities similar to Nafion.RTM.. These improved properties may allow direct methanol fuel cells to operate at higher temperatures and with higher efficiencies due to reduced methanol crossover.

  10. Advances in directed self assembly integration and manufacturability at 300 mm

    NASA Astrophysics Data System (ADS)

    Rathsack, Benjamen; Somervell, Mark; Muramatsu, Makato; Tanouchi, Keiji; Kitano, Takahiro; Nishimura, Eiichi; Yatsuda, Koichi; Nagahara, Seiji; Iwaki, Hiroyuki; Akai, Keiji; Ozawa, Mariko; Romo Negreira, Ainhoa; Tahara, Shigeru; Nafus, Kathleen

    2013-03-01

    Directed self-assembly (DSA) has the potential to extend scaling for both line/space and hole patterns. DSA has shown the capability for pitch reduction (multiplication), hole shrinks, CD self-healing as well as a pathway towards LWR and pattern collapse improvement [1-10]. TEL has developed a DSA development ecosystem (collaboration with customers, consortia, inspection vendors and material suppliers) to successfully demonstrate directed PS-PMMA DSA patterns using chemo-epitaxy (lift-off and etch guide) and grapho-epitaxy integrations on 300 mm wafers. New processes are being developed to simplify process integration, to reduce defects and to address design integration challenges with the long term goal of robust manufacturability. For hole DSA applications, a wet development process has been developed that enables traditional post-develop metrology through the high selectivity removal of PMMA cylindrical cores. For line/ space DSA applications, new track, cleans and etch processes have been developed to improve manufacturability. In collaboration with universities and consortia, fundamental process studies and simulations are used to drive process improvement and defect investigation. To extend DSA resolution beyond a PS-PMMA system, high chi materials and processes are also explored. In this paper, TEL's latest process solutions for both hole and line/space DSA process integrations are presented.

  11. Policy Options for Use of Media Directed to Increase the Supply of Bachelors Educated Nurses in the U.S.A.

    ERIC Educational Resources Information Center

    Kloc, Michelle L.

    2010-01-01

    The national nursing shortage poses health risks to patients and the community. One approach used to mitigate the shortage is increasing interest in nursing as a desirable career among high school and college-age individuals. One method used to promote nursing as a career is via promotional advertisements in media (i.e. television, internet,…

  12. Direct Activation of ENaC by Angiotensin II: Recent Advances and New Insights

    PubMed Central

    Zaika, Oleg; Mamenko, Mykola; Staruschenko, Alexander

    2012-01-01

    Angiotensin II (Ang II) is the principal effector of the renin-angiotensin-aldosterone system (RAAS). It initiates myriad processes in multiple organs integrated to increase circulating volume and elevate systemic blood pressure. In the kidney, Ang II stimulates renal tubular water and salt reabsorption causing antinatriuresis and antidiuresis. Activation of RAAS is known to enhance activity of the epithelial Na+ channel (ENaC) in the aldosterone-sensitive distal nephron. In addition to its well described stimulatory actions on aldosterone secretion, Ang II is also capable to directly increase ENaC activity. In this brief review, we discuss recent findings about non-classical Ang II actions on ENaC and speculate about its relevance for renal sodium handling. PMID:23180052

  13. Advancing lignocellulose bioconversion through direct assessment of enzyme action on insoluble substrates.

    PubMed

    Goacher, Robyn E; Selig, Michael J; Master, Emma R

    2014-06-01

    Microbial utilization of lignocellulose from plant cell walls is integral to carbon cycling on Earth. Correspondingly, secreted enzymes that initiate lignocellulose depolymerization serve a crucial step in the bioconversion of lignocellulosic biomass to fuels and chemicals. Genome and metagenome sequencing efforts that span the past decade reveal the diversity of enzymes that have evolved to transform lignocellulose from wood, herbaceous plants and grasses. Nevertheless, there are relatively few examples where 'omic' technologies have identified novel enzyme activities or combinations thereof that dramatically improve the economics of lignocellulose bioprocessing and utilization. A likely factor contributing to the discrepancy between sequence-based enzyme discovery and enzyme application is the common practice to screen enzyme candidates based on activity measurements using soluble model compounds. In this context, the development and application of imaging, physicochemical, and spectromicroscopic techniques that allow direct assessment of enzyme action on relevant lignocellulosic substrates is reviewed.

  14. Assisting undergraduate nursing students to learn evidence-based practice through self-directed learning and workshop strategies during clinical practicum.

    PubMed

    Zhang, Qi; Zeng, Tieying; Chen, Ying; Li, Xiaopan

    2012-07-01

    To equip undergraduate nursing students with basic knowledge and skills and foster positive attitudes toward evidence-based practice (EBP), a pilot learning program during their clinical practicum was developed in a teaching hospital in China. This article describes the specific learning process through which self-directed learning and workshop strategies were used, and a pre- and post-intervention survey were conducted to evaluate the effectiveness of the learning strategies. The findings show a significant improvement in their perceptions of EBP knowledge, attitudes and beliefs, and behavior levels. Beginning competencies in EBP were achieved. Participants reported great satisfaction and have found this program helpful in promoting their analytical and problem-solving abilities, independent learning ability, and cooperative and communication abilities as well.

  15. Developing an information systems strategy for nursing.

    PubMed

    Callanan, K M; Hughes, S J

    1995-01-01

    With the rapidly changing health care environment and information technology advances, organizations need to engage in strategic, planned change in order to allocate limited resources, achieve the organization's goals, and fulfill its mission [1]. One of the most important aspects of the organization's planned strategies for change concerns the information systems. The involvement of the nursing department in this process is critical. This poster presentation will communicate how nurses can develop an information systems strategic plan that will enable them to play an active role as contributors and vital participants in the strategic and business planning processes for information systems. This information systems strategy for nursing will: a) provide direction and purpose, b) guide nursing in identifying the kinds of information technology needed, c) assist in timely implementation of a system that supports nursing, and d) identify desired outcomes and benefits of an information system. The nursing information systems plan must be built on, and support, the organization's mission and business plan and integrate into the over-all information systems plans [2]. Components of the nursing strategic plan include the nursing mission statement and vision, an assessment of the current environment to identify supporting technology needed to achieve the nursing vision, expectations/anticipated outcomes, environmental considerations, and special staffing/expertise considerations. The nursing vision and mission statement is an articulation of the overall direction and purpose of the nursing organization. An assessment of the nursing organization, problem areas, opportunities for growth, the physical environment, existing systems, communications requirements, and resources is carried out to help identify areas where new technologies and automated methods of managing information could be applied. Special staffing and expertise not currently available in the organization, but

  16. Modifiable Factors that Support Political Participation by Nurses.

    PubMed

    Woodward, Bobbi; Smart, Denise; Benavides-Vaello, Sandra

    2016-01-01

    Political participation is an opportunity for individuals to give their time and energy in such a way that it benefits others and advances relevant agendas. Political participation is a key issue for nurses because they are familiar with clinical issues that directly impact health care policies instituted at the local, state, and federal levels. Collectively, nurses also represent the largest number of health care providers in the United States and are among the most trusted health professionals. However, there are many obstacles that prevent nurses from taking a more active role in politics, creating a gap in how nurses pursue and respond to political participation, or civic engagement. The purpose of this exploratory review is to identify modifiable factors that support political participation among nurses. A review of the extant literature revealed three primary factors that promote civic engagement among nurses: (a) integration of political education in the nursing curriculum; (b) value of active psychological engagement, including a personal interest in political knowledge and information; and (c) value of collective influence such as membership in professional organizations.

  17. Knowledge and Skills for Nurse Administrators.

    ERIC Educational Resources Information Center

    Mark, Barbara A.; And Others

    1990-01-01

    Looks at the education needs of nurse executives and nurse managers and compares them to the typical education provided in nursing administration programs. Concludes that educators need to be directly involved in hospital settings in order to update nursing administration education. (JOW)

  18. [Gender mainstreaming and nursing].

    PubMed

    Wang, Hsiu-Hung

    2011-12-01

    Gender mainstreaming is one of the most important strategies in promoting global gender equality. The Taiwan government launched policies on gender mainstreaming and gender impact assessment in 2007 in response to strong public and academic advocacy work. With rising awareness of gender issues, nursing professionals in Taiwan should keep pace with global trends and become actively involved in advancing gender-mainstreaming policies. This article shows that nursing professionals should prepare themselves by cultivating gender competence, understanding gender-related regulations, recognizing the importance of gender impact assessment implementation, integrating gender issues into nursing education, conducting gender-related research and participating in decision-making processes that promote gender mainstreaming. Nursing professionals should enhance their knowledge and understanding of gender mainstreaming-related issues and get involved in the gender-related decision-making process in order to enhance gender awareness and women's health and further the professional development of nurses.

  19. Qualitative Distinctions and Similarities in the Practice of Clinical Nurse Specialists and Nurse Practitioners.

    ERIC Educational Resources Information Center

    Fenton, Mary V.; Brykczynski, Karen A.

    1993-01-01

    A comparison of results of two studies regarding the actual practice of clinical nurse specialists and nurse practitioners revealed a shared core of advanced practice competencies as well as distinct differences between practice roles. (JOW)

  20. Advanced flow-control mechanisms for the sockets direct protocol over infiniband.

    SciTech Connect

    Balaji, P.; Bhagvat, S.; Panda, D. K.; Thakur, R.; Gropp, W.; Mathematics and Computer Science; Dell Inc.; Ohio State Univ.

    2007-01-01

    The Sockets Direct Protocol (SDP) is an industry standard to allow existing TCP/IP applications to be executed on high-speed networks such as InfiniBand (IB). Like many other high-speed networks, IB requires the receiver process to inform the network interface card (NIC), before the data arrives, about buffers in which incoming data has to be placed. To ensure that the receiver process is ready to receive data, the sender process typically performs flow-control on the data transmission. Existing designs of SDP flow-control are naive and do not take advantage of several interesting features provided by IB. Specifically, features such as RDMA are only used for performing zero-copy communication, although RDMA has more capabilities such as sender-side buffer management (where a sender process can manage SDP resources for the sender as well as the receiver). Similarly, IB also provides hardware flow-control capabilities that have not been studied in previous literature. In this paper, we utilize these capabilities to improve the SDP flow-control over IB using two designs: RDMA-based flow-control and NIC-assisted RDMA-based flow-control. We evaluate the designs using micro-benchmarks and real applications. Our evaluations reveal that these designs can improve the resource usage of SDP and consequently its performance by an order-of-magnitude in some cases. Moreover we can achieve 10-20% improvement in performance for various applications.