What perioperative and emerging workforce nurses want in a manager

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THE WORLD is experiencing a critical shortage of RNs. As the number of nurses decreases, it is unclear how already vulnerable specialty areas, such as perioperative nursing, will be affected by the emerging workforce's career decisions.

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THIS DESCRIPTIVE, COMPARATIVE study explores perioperative nurses' and nursing students' perceptions of the top 10 characteristics desired in a manager.

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EVEN WITH 70% CONGRUENCY, significant differences were found in how nurses and students ranked the traits they valued.

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THIS STUDY highlights the trails managers need to transform new graduate nurses into satisfied, productive members of the perioperative team. AORN J 78 (August 2003) 246-261.

     

Time to and predictors of dual incontinence in older nursing home admissions

Aims

There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents.

Methods

Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home‐specific random effect was used.

Results

At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care.

Conclusions

The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents.     

Risk and protective factors for sexual risk taking among adolescents involved in Prime Time

This article describes a preliminary qualitative evaluation of risk and protective factors associated with consistent contraceptive use and healthy sexual decision-making among ten of the first participants in the Prime Time intervention study. Prime Time is an 18-month intervention including one-on-one case management and peer educator training targeting sexually active 13-17-year-old girls who are recruited from health care clinics. Using an approach grounded in findings from previous research, social cognitive theory, and the social development model, Prime Time aims to improve participants' contraceptive use consistency, reduce number of sexual partners, and reduce unwanted sexual activity. Findings from this preliminary evaluation alert health care providers to the complex and dynamic nature of adolescent girls' sexual behaviors and to a broad range of risk and protective factors within individuals and their environments that may influence adolescent girls' sexual behaviors and contraceptive use. Findings suggest that an ongoing, supportive relationship with a case manager who is able to pace and tailor an intervention to the individual young person can have positive effects on adolescent girls' sexual behaviors and contraceptive use.     

Influence of Age on the Clinical Outcome of Breast Cancer for Men and the Development of Second Primary Cancers

Background

Low incidence of breast cancer in men (BCM) (<?1% of all breast cancers) has led to a paucity of outcome data. This study evaluated the impact of age on BCM outcomes.

Methods

For this study, BCM patients treated between 2000 and 2011 were stratified by age (≤?65 or?>?65 years). Kaplan–Meier methods were used to compare overall survival (OS) and breast cancer-specific survival (BCSS). Competing-risk methods analyzed time to second primary cancers (SPCs), with any-cause death treated as a competing risk.

Results

The study identified 152 BCM patients with a median age of 64 years (range 19–96 years). The median body mass index (BMI) was 28 kg/m². Men age 65 years or younger (n?=?78, 51%) were more overweight/obese than men older than 65 years (n?=?74, 49%) (89% vs 74%, respectively; P?=?0.008). Both groups had similar nodal metastases rates (P?=?0.4), estrogen receptor positivity (P?=?1), and human epidermal growth factor receptor 2 (HER2)neu overexpression (P?=?0.6). Men 65 years of age or younger were more likely to receive chemotherapy (P?=?0.002). The median follow-up period was 5.8 years (range 0.1–14.4 years). The 5-year OS was 86% (95% confidence interval [CI] 80–93%), whereas the 5-year BCSS was 95% (95% CI 91–99%). The BCM patients 65 years of age and younger had better OS (P?=?0.003) but not BCSS (P?=?0.8). The 5-year cumulative incidence of SPC was 8.4% (95% CI 3.4–13.4%). The prior SPC rate was higher for men older than 65 years (n?=?20, 31%) than for those age 65 years or younger (n?=?7, 11%) (P?=?0.008). This did not account for differences in life years at risk. No difference was observed in SPC cumulative incidence stratified by age (P?=?0.3).

Conclusions

Men 65 years of age or younger received more chemotherapy and had improved OS, but not BCSS, compared with men older than 65 years. For all BCM, SPC is a risk, and appropriate screening may be warranted.

     

Dynamic Three-Dimensional Ultrasound to Evaluate Scapular Movement Among Manual Wheelchair Users and Healthy Controls

Background:

A large percentage of individuals with spinal cord injury (SCI) report shoulder pain that can limit independence and quality of life. The pain is likely related to the demands placed on the shoulder by transfers and propulsion. Shoulder pathology has been linked to altered scapular mechanics; however, current methods to evaluate scapular movement are invasive, require ionizing radiation, are subject to skin-based motion artifacts, or require static postures.

Objective:

To investigate the feasibility of applying 3-dimensional ultrasound methods, previously used to look at scapular position in static postures, to evaluate dynamic scapular movement.

Method:

This study evaluated the feasibility of the novel application of a method combining 2-dimensional ultrasound and a motion capture system to determine 3-dimensional scapular position during dynamic arm elevation in the scapular plane with and without loading.

Results:

Incremental increases in scapular rotations were noted for extracted angles of 30°, 45°, 60°, and 75° of humeral elevation. Group differences were evaluated between a group of 16 manual wheelchair users (MWUs) and a group of age- and gender-matched able-bodied controls. MWUs had greater scapular external rotation and baseline pathology on clinical exam. MWUs also had greater anterior tilting, with this difference further accentuated during loading. The relationship between demographics and scapular positioning was also investigated, revealing that increased age, pathology on clinical exam, years since injury, and body mass index were correlated with scapular rotations associated with impingement (internal rotation, downward rotation, and anterior tilting).

Conclusion:

Individuals with SCI, as well as other populations who are susceptible to shoulder pathology, may benefit from the application of this imaging modality to quantitatively evaluate scapular positioning and effectively target therapeutic interventions.Key words: kinematics, scapula, ultrasound, wheelchair userThe shoulder is a common site of injury across many populations. Because it is the most mobile joint in the body, the high prevalence of disorders is not surprising. Individuals are at increased risk for shoulder pathology when exposed to high forces, sustained postures, and repetitive movements.¹ Wheelchair users are exposed to all of these factors in activities of daily living. Among manual wheelchair users (MWUs), 35% to 67% report shoulder pain.^2–7 In this population, the presence of shoulder dysfunction significantly affects function and decreases quality of life.^8,9 With altered scapular kinematics being linked to a multitude of shoulder problems, the identification of changes in kinematics may allow for earlier detection of pathology and targeting of appropriate interventions.^10–25 However, evaluation of dynamic scapular movement is a challenging task, as the scapula rotates about 3 axes while also gliding underneath overlying tissue. Direct visualization of the bone is ideal but is often limited by cost, availability, and exposure to radiation, and skin-based systems are prone to error.^26–33The overall goal of this study was to investigate the feasibility of applying 3-dimensional ultrasound methods, previously used to look at scapular position in static postures, to evaluate dynamic scapular movement.³⁴ The specific goals were as follows:

1. Evaluate intermediate angles of functional elevation during dynamic movement (30°, 45°, 60°, and 75°). We hypothesize that we will see incremental increases in external rotation, upward rotation, and posterior tipping throughout the movement to maintain the distance between the acromion and humerus.
2. Compare dynamic scapular movement between MWUs and able-bodied controls (ABs). We anticipate that the nature of wheelchair propulsion and demands of activities of daily living will elucidate differences between this population and ABs with comparably lower daily demands on the shoulder.
3. Evaluate the effect of loading on scapular movement, as other studies have suggested that differences in kinematics are clearer in the presence of loading.^10,35,36
4. Investigate the relationship between shoulder pathology, age, years since injury, and body mass index (BMI) and scapular positioning.