Prosecutor Preference for Forensic Nurse Testimony: Outcome of Expanding a Forensic Program

IntroductionThe objective was to evaluate the impact of using forensic nurse examiners for patients with trauma on prosecutors’ preference for testimony in criminal court.MethodsA retrospective chart review of a database of 562 subpoenas received from January 2012 to December 2017 was conducted for patients with trauma seen in a level 1 trauma center with a comprehensive forensic nursing program.ResultsThe prosecutors’ preferences in 453 of the 562 subpoenas received by the Forensic Nurse Examiners program involving a patient with trauma were analyzed. The prosecutors preferred the use of the forensic nurse examiner alone in 441 of the 453 cases (97.4%), with a decrease (100% to 2.7%) in preference for physicians testifying in criminal court after the expansion of our forensic nursing program compared with previous years before the program expansion.DiscussionThe quality of the expanded Forensic Nurse Examiner program was validated by an increased prosecutor preference for forensic nurse examiner testimony in criminal court as the program matured over the years.     

Beyond STRs: The Role of Diallelic Markers in Forensic Genetics

Short tandem repeat (STR) polymorphisms have been firmly established as standard DNA marker systems since more than 15 years both in forensic stain typing as well as in paternity and kinship testing. However, when analyzing genetic relationships in deficiency cases, STRs have a couple of disadvantages due to the sometimes poor biostatistical efficiency as well as the possibility to observe one or more genetic inconsistencies that could also be explained by mutational events. In such situations, additional robust markers with negligible mutations rates such as single nucleotide polymorphisms (SNPs) and insertion/deletion markers (indels) can be used as adjuncts to provide decisive genetic information in favor for or against the assumed relationship. Both SNPs and indels can now be typed more easily using multiplexes of up to 50 loci based on fragment length analysis on instruments available in all routine forensic and paternity testing laboratories, thus making it possible to extend the range of markers beyond the currently used STRs.     

An Emerging Role: The Nurse Content Curator

A new phenomenon, the inverted or “flipped” classroom, assumes that students are no longer acquiring knowledge exclusively through textbooks or lectures. Instead, they are seeking out the vast amount of free information available to them online (the very essence of open source) to supplement learning gleaned in textbooks and lectures. With so much open‐source content available to nursing faculty, it benefits the faculty to use readily available, technologically advanced content. The nurse content curator supports nursing faculty in its use of such content. Even more importantly, the highly paid, time‐strapped faculty is not spending an inordinate amount of effort surfing for and evaluating content. The nurse content curator does that work, while the faculty uses its time more effectively to help students vet the truth, make meaning of the content, and learn to problem‐solve.

Brooks     

The Administration of Moderate Sedation and the Role of the Radiology Nurse

BackgroundModerate sedation administration is an assumed role of the nurse in interventional radiology. There remains limited documentation to define this practice and its relationship to the radiology nurse. The use of moderate sedation is common for patients receiving interventional radiology procedures, and therefore, defining the administrative parameters for this variable will allow for the future study of outcomes for this patient population. The primary aim of this article is to describe moderate sedation parameters in interventional radiology in hospitals offering adult interventional radiology services. Parameters included total case volumes, presence of provider type during interventional radiology cases using moderate sedation, existence of moderate sedation privileges, and the total percentage of moderate sedation administration by provider type. The results of this study are part of a larger nationwide survey that described administratively mediated variables in interventional radiology.MethodsA 26-question survey was developed and sent to a sample of radiologic administrators (n = 510) across the United States. The survey was developed using the Minnick and Roberts Outcomes Production Model, which identifies the relationship among essential health services concepts and their influence on patient outcomes. Recipients could answer via paper survey or by electronic link. Completion of the survey constituted consent.ResultsA total of 82 individuals responded to the survey (response rate = 16.8%). Respondents reported a median value of 2656.5 (n = 74, IQR: 1175.0, 5833.0) interventional radiology cases completed in the last year and a median value of 1500 patients receiving moderate sedation (n = 82, IQR: 600.0, 2725.0). Respondents reported that the registered nurse was responsible for a median of 90.0% of the sedation administered for adult patients (IQR: 80.0, 98.0).ConclusionsBased on the results of the survey, it is determined that moderate sedation is primarily administered by the registered nurse in interventional radiology. Future studies can include relational designs that focus on aspects of the registered nurse as a highly influential factor in moderate sedation patient outcomes.     

The Medical‐Surgical Nurse Perspective of Advocate Role

Nursing advocacy for patients is viewed as a vital role for the nursing profession; however, there is little empirical research regarding nursing advocacy. PROBLEM. The medical‐surgical nursing specialty is the largest specialty in acute care settings, but few advocacy studies have focused exclusively on this specialty population. METHODS. The purpose of this study was to explore the nurse advocacy actions and workplace support for advocacy using written narrative responses to a mailed survey using a medical‐surgical nursing sample. FINDINGS. The responses help to illuminate the importance of the advocate role for this nursing specialty and provide preliminary information on the advocacy actions and workplace support as reported by the nurses. CONCLUSIONS. The resulting data provide a basis for examining the workplace environmental support for nursing advocacy, further delineate the actions of the nurse advocate, and clarify how nurse advocates follow patient desires regarding care. In addition, the results can be used in education, improving advocacy skills, and safety initiatives.     

口腔专科医院护士人力资源管理

目的解决口腔医院门诊护士短缺,年龄老化,护理工作被动的情况,促进口腔专科四手操作护理技术的开展。方法回顾某院近10年来护士人力资源管理制度改革的过程,实行按需设岗,公开招聘,专科护理技术培训,持证上岗,按岗定薪,合理分层次使用护士,并借鉴国际上通过使用低学历牙医助理来执行“四手操作,”完成椅旁护理工作,降低人工成本。结果通过改革护士人力资源管理制度,建立了一套适合口腔医院特点的护士人力资源管理制度,在解决护士短缺、提高成本效益的同时,有效促进了四手操作护理技术开展和护理安全。结论建立适合口腔医院特点的护理人力资源管理制度,是发展现代口腔专科护理的需要。     

军队中小医院创伤外科护士工作压力源的分析与应对

目的针对我科护士工作中的压力源进行问卷调查和分析,并据此提出合理的建议和意见,减轻压力,提高护理质量。方法采用随机抽样方法,对我科68名护士进行问卷调查并分析。结果在护士工作压力源5个条目35项压力源中,有10项给护士带来重度水平压力。主要有护理工作的社会地位低,工资及其它的福利待遇低,工作分工不明确,工作量太大,上班的护士数量少,非护理性的工作太多,无用的书面工作太多,缺乏病人教育的有关知识,护理管理者的理解与支持不够,护理管理者的批评过多。结论创伤外科护士承受着多种工作压力源,各级领导应采取行之有效的措施减轻护士的压力,提高护理质量。     

Hospital Nurses' Perception of the Geriatric Nurse Practice Environment

Purpose: To test the relationship between nurses' perceptions of the geriatric nurse practice environment (GNPE) and perceptions of geriatric-care delivery, and geriatric nursing knowledge.
Design: A secondary analysis of data collected by the New York University Hartford Institute Benchmarking Service staff using a retrospective, cross-sectional, design.
Methods: Responses of 9,802 direct-care registered nurses from 75 acute-care hospitals in the US that administered the GIAP (Geriatric Institutional Assessment Profile) from January 1997 to December 2005 were analyzed using linear mixed effects modeling to explore associations between variables while controlling for potential covariates.
Findings: Controlling for hospital and nurse characteristics, a positive geriatric nurse practice environment was associated with positive geriatric care delivery (F=4,686, p<.0001) but not geriatric nursing knowledge. The independent contribution of all three dimensions of the geriatric nurse practice environment (resource availability, institutional values, and capacity for collaboration) influences care delivery for hospitalized older-adult patients.
Conclusions: Organizational support for geriatric nursing is an important influence upon quality of geriatric care.
Clinical Relevance: Hospitals that utilize an organizational approach addressing the multifaceted nature of the GNPE are more likely to improve the hospital experience of older adults.     

Nurse executive director effectiveness: a systematic review of the literature

AIM: This report systematically reviews studies of nurse executive director effectiveness to identify recurring themes that might inform current practice and future research. BACKGROUND: Increasing competition in healthcare markets is increasing the demands on nurse executive directors. There is a need to identify factors that contribute to effectiveness in the role so that these can be developed and effectiveness improved. EVALUATION: Reports were identified using electronic databases, an internet search and review of references in all reports initially identified. The methodology of these reports was reviewed and recurring themes were identified. KEY ISSUES: Ten themes that might be associated with nurse executive director effectiveness emerged from the review. CONCLUSIONS: The literature relating to nurse executive director effectiveness is limited but there are sufficient recurring themes to inform current practice and to investigate in new research.     

护士长总值班制在护理风险管理中的作用

目的评价护士长总值班制在护理风险管理中的作用。方法回顾性分析2008-2009年某院护士长值班工作记录资料、护理部关于护理安全事件发生情况及患者对护理工作的满意率资料。结果 2008年、2009年护理安全事件发生率比2007年分别下降了10.00%和12.00%,抢救成功率比2007年分别上升了2.35%和3.26%,患者对护理工作的满意率也比2007年提高了2.98%和3.15%。结论护士长总值班的设立,有效地应对了突发事件,减少了护理不良事件的发生;能及时化解医疗、护理纠纷,提高患者对护理工作的满意率,对防止护理风险的发生起到良好的作用。     

The Retirement of a Public Health Nurse Leader

ABSTRACT Elizabeth Gordon Fox was a distinguished member of the profession and an influential advocate for visiting nurse services at the time of her retirement. The dinner guests who came to honor her 20 years as director of the New Haven, Connecticut Visiting Nurse Association included luminaries in public health including Thomas Parran, Ira V. Hiscock, Ruth Hubbard, and Anna Fillmore. Dr. C.-E. A. Winslow, an eminent leader in public health, and Annie Warburton Goodrich, the retired dean of the Yale School of Nursing were also present. The occasion was marked by an address by Thomas Parran, former U. S. Surgeon General, who focused attention on nursing leadership in public health. Speeches by both Parran and Fox addressed the challenges faced at mid-century—challenges of public accountability, of a widespread nursing shortage, and of the need to distribute knowledge and services with both efficiency and compassion. Dr. Parran's talk and an excerpt from Fox's comments that evening were published in Public Health Nursing in December 1949. Selected passages from each of their speeches recall for contemporary readers the concerns of the era and the hopes of those who had dedicated their professional careers to improvement of the health of the public.